Postextubation Stridor: An Analysis of Incidence, Risk Factors, and Clinical Outcomes in Mechanically Ventilated Patients.

Background Postextubation stridor (PES) is a potentially life-threatening complication following endotracheal intubation. However, detailed reports on its incidence and outcomes remain limited under standardized extubation protocols. In this study, we aimed to investigate the incidence, clinical characteristics, risk factors, and outcomes of PES, and evaluate the cuff leak test (CLT) for predicting PES. Methods This retrospective study included all patients who received mechanical ventilation for 48 hours or more at a single tertiary care center between January 2009 and December 2023. A comprehensive ventilator weaning and extubation protocol was implemented. Risk factors for PES were analyzed using univariate and multivariable logistic regression. Results Of 651 eligible patients, 22 (3.4%) developed PES. Among them, 14 (63.6%) were female, and 18 (81.8%) had passed the CLT. The reintubation rate was 36.4% (8/22). The 30-day and 60-day mortality rates were both 0% (0/22), and no deaths were attributable to PES. Treatment included epinephrine inhalation (13/22, 59.1%), noninvasive ventilation (11/22, 50.0%), and steroid administration (6/22, 27.3%). Multivariable analysis identified female sex (OR 3.65; 95% CI 1.49-9.47; p = 0.005) as the only factor independently associated with PES. Failed CLT did not reach statistical significance in the multivariable model (OR 3.21; 95% CI 0.85-9.84; p = 0.056). The CLT demonstrated high specificity (95.9%; 95% CI, 94.0-97.3%) but low sensitivity (18.2%; 95% CI, 5.2-40.3%) for predicting PES; however, these estimates are confounded by prophylactic corticosteroid administration in nearly all patients who failed the CLT. Conclusions PES remains a significant complication with high reintubation rates despite low overall incidence. Female sex was the only factor independently associated with PES in this cohort. The diagnostic performance of the CLT is confounded by the treatment paradox, and its low sensitivity necessitates vigilant post-extubation monitoring regardless of CLT results.