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العنوان
Laryngeal ultrasound versus cuff leak test in prediction of post extubation laryngeal edema /
المؤلف
Kassem, Mostafa Aboelyazeed.
هيئة الاعداد
باحث / مصطفي أبواليزيد مصطفي قاسم
مشرف / سحر محمد كمال محمود حسانين
مشرف / وليد عبدالله ابراهيم احمد
مشرف / محمد معين محمد السعيد عليوة
تاريخ النشر
2019.
عدد الصفحات
106 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
العناية المركزة والطب العناية المركزة
تاريخ الإجازة
1/1/2019
مكان الإجازة
جامعة عين شمس - كلية الطب - التخدير والرعاية المركزة وعلاج الآلم
الفهرس
Only 14 pages are availabe for public view

from 106

from 106

Abstract

The Post extubation Laryngeal edema is a common cause of obstruction of the upper air way after extubation in critical care patients and is thought to arise from direct mechanical trauma to the larynx by the endotracheal tube. The severity of airway obstruction due to laryngeal edema varies up to emergency reintubation. Reintubation itself is associated with increased mechanical ventilation days and length of stay in the critical care unit, higher costs, morbidity and mortality. There is a substantial need to identify a test to confirm or exclude the presence of significant laryngeal edema before extubation.
The purpose of this study was to determine the accuracy of bedside ultrasound in the ICU in predicting post extubation stridor (PES) versus the cuff leak test.
The current study was a prospective observational cohort study enrolled 75 patients admitted to AIN SHAMS Main University Hospital, who were planned for extubation. The air column width difference (ACWD) was measured before planned extubation using portable ultrasound and cuff leak test was measured by the spirometery function of the mechanical ventilation The primary goal was to assess the diagnostic accuracy of ACWD to predict the presence of significant laryngeal edema, enough to cause PES.
The results showed that the prevalence of LE was 18.7%. The data collected from patients, with and without, PES showed no definite risk factors for PES. A cut off point of 0.9 mm change in ACWD (air column width difference at vocal cords) was identified (p= 0.0014), below which high probability of developing PES was noticed. The sensitivity and specificity of ACWD below or equal to 0.9 mm were 88% and 82% in predicting PES respectively, with negative predictive value of 0.83 and positive predictive value of 0.86.while the cuff leak test on cutoff point of 110 ml show p value equal 0.0016 with senetivity and specifity of 68% and 89% with negative predictive value of 0.87 and positive predictive value of 0.69.