الفهرس 
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Abstract
Endotracheal intubation is commonly used in (ICU) for different causes. However, intubation/extubation may lead to the development of complications such as post extubation stridor (PES), one of the most frequent causes of reintubation, prolonged mechanical ventilation, and increased morbidity in the ICU patients.
PES and upper-airway obstruction are multifactorial in etiology and can occur as a result of laryngotracheal edema, intubation trauma, excessive cuff pressure with mucosal ulceration, and prolonged intubation with secondary inflammation and granuloma formation.
Factors associated with the development of PES include older age, female gender, size of endotracheal tube, presence of cuffed tube, prolonged intubation period, presence of an underlying airway disease, traumatic intubation, tracheal aspiration, tube mobility and patient fighting against the endotracheal intubation.
The severity of airway obstruction due to laryngeal edema varies. In more severe cases, the edema can lead to acute respiratory compromise necessitating emergency reintubation. Reintubation itself is associated with increased mechanical ventilation days and length of stay in the intensive care unit, higher costs, morbidity and mortality.
So, diagnosis of PES is of significant clinical importance as these patients can benefit from close monitoring and specific therapies. However, there is no definitive method to identify patients at risk of PES.
Cuff leak test (CLT), illustrating a leak around the endotracheal tube with the cuff deflated, has been proposed as a simple method of predicting the occurrence of PES. CLT consists of deflating the balloon cuff of the endotracheal tube in order to assess the air leak around the tube, permitting an indirect evaluation of upper airway patency while the patient is sedated, in supine position, and on volume controlled mechanical ventilation.
A reduced cuff-leak volume identifies a population at increased risk for the development of PES. However, cut-off point of the cuff-leak volume substantially differs between previous studies and the controversial results may cause physicians to make difficult decisions regarding extubation if the CLT is positive. On the other hand, laryngeal ultrasonography including measurement of air column width (width of air Passed through the vocal cords as determined by US) and ACWD (difference in width of air column during balloon- cuff inflation and deflation) also while the patient is sedated, in supine position and on volume controlled mechanical ventilation could predict post extubation stridor.
The aim of this study was to evaluate the value of laryngeal ultrasonography versus cuff leak test in predicting post extubation stridor,
We found that:
• In our study CLT identified PES patients with a sensitivity of 75%. But with low PPV of 50% for leakage volume of (132.5mm).
Laryngeal ultrasound showed a sensitivity of 50% for those patients with air column width before deflation less than10.955 mm and ACWD 0.905 mm with PPV of 11.8% and 14.3% for air column width and ACWD respectively.