%0 Journal Article %A Georges Abi Abdallah %A Alexis Ferré %A Antoine Gros %A Christelle Simon %A Fabrice Bruneel %A Stéphanie Marque-Juillet %A Stéphane Legriel %A Marine Paul %T Postextubation Stridor in Severe COVID-19 %D 2022 %R 10.4187/respcare.09527 %J Respiratory Care %P 638-646 %V 67 %N 6 %X BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, 60–80% 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 2016–2019. 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 1.24–12.14], P = .02), female sex (odds ratio 5.77 [95% CI 2.30–15.64], P < .001), and tube mobilization or re-intubation or prone positioning (odds ratio 3.01 [95% CI 1.04–9.44], 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. %U https://rc.rcjournal.com/content/respcare/67/6/638.full.pdf