@article {Abdallah638, author = {Georges Abi Abdallah and Alexis Ferr{\'e} and Antoine Gros and Christelle Simon and Fabrice Bruneel and St{\'e}phanie Marque-Juillet and St{\'e}phane Legriel and Marine Paul}, title = {Postextubation Stridor in Severe COVID-19}, volume = {67}, number = {6}, pages = {638--646}, year = {2022}, doi = {10.4187/respcare.09527}, publisher = {Respiratory Care}, abstract = {BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, 60{\textendash}80\% of patients admitted to ICU require mechanical ventilation for respiratory distress. We aimed to compare the frequency of postextubation stridor (PES) and to explore risk factors in COVID-19 subjects compared to those without COVID-19.METHODS: We performed an observational retrospective study on subjects admitted for severe COVID-19 requiring mechanical ventilation \> 48 h during the first and second waves in 2020 and compared these subjects to historical controls without COVID-19 who received mechanical ventilation \> 48 h between 2016{\textendash}2019. The primary outcome was the frequency of PES, defined as audible stridor within 2 h following extubation.RESULTS: Of the 134 subjects admitted with severe COVID-19 requiring mechanical ventilation, 96 were extubated and included and compared to 211 controls. The frequency of PES was 22.9\% in the COVID-19 subjects and 3.8\% in the controls (P \< .001). Factors independently associated with PES were having COVID-19 (odds ratio 3.72, [95\% CI 1.24{\textendash}12.14], P = .02), female sex (odds ratio 5.77 [95\% CI 2.30{\textendash}15.64], P \< .001), and tube mobilization or re-intubation or prone positioning (odds ratio 3.01 [95\% CI 1.04{\textendash}9.44], P = .047) after adjustment on Simplified Acute Physiology Score II expanded). During the first wave, PES was significantly more common in subjects with a positive SARS-CoV-2 RT-PCR test on tracheal samples on the day of extubation (73.3\% vs 24.3\%, P = .018).CONCLUSIONS: PES affected nearly one-quarter of subjects with COVID-19, a proportion significantly higher than that seen in controls. Independent risk factors for PES were COVID-19, female sex, and tube mobilization or re-intubation or prone positioning. PES was associated with persistent viral shedding at the time of extubation.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/67/6/638}, eprint = {https://rc.rcjournal.com/content/67/6/638.full.pdf}, journal = {Respiratory Care} }