EXTUBATION FAILURE DUE TO POSTEXTUBATION STRIDOR IS BETTER CORRELATEDWITH NEUROLOGIC IMPAIRMENT THAN WITH UPPER AIRWAY LESIONS IN CRITICALLY ILL PEDIATRIC-PATIENTS

The incidence of post-extubation strider (PES) in a pediatric intensiv e care unit (PICU) and the need for reintubation is not known. Predict ors of success on a subsequent extubation attempt and the efficacy of dexamethasone treatment prior to a subsequent extubation attempt are n ot established. In a prospective randomized double blind-controlled st udy in two PICU's in a university children's hospital setting, of 5,56 6 admissions over 35-months, we identified 32 patients who failed prim ary extubation and were reintubated for PES. Twenty-six patients were enrolled in the study and three subsequently excluded. Twelve were ran domized to receive dexamethasone and 11 received sodium chloride place bo. Fifteen patients succeeded study extubation and eight failed. Of t hose receiving dexamethasone, nine patients succeeded and three failed . Of those receiving placebo, six patients succeeded and five failed. There was a poor correlation between anatomical abnormalities of the a irway and failure of study extubation. Extubation failure was better c orrelated with neurologic impairment in the patients. We present a str ider score and demonstrate that it is an excellent predictor of succes s versus failure for the study extubation. Dexamethasone pre-treatment did not reduce strider score. We are unable to conclude if dexamethas one pre-treatment reduces extubation failure. We speculate that neurol ogic impairment leads to extubation failure in critically ill pediatri c patients. (C) 1997 Elsevier Science Ireland Ltd.