PRE-EXTUBATION LARYNGEAL AIR COLUMN WIDTH DIFFERENCE AS A PREDICTOR OF POST EXTUBATION UPPER AIRWAY OBSTRUCTION AND EXTUBATION OUTCOME IN PEDIATRIC ICU PATIENTS

Abstract

Introduction: Post-extubation upper airway obstruction remains a significant complication among critically ill pediatric patients and may lead to respiratory distress, delayed recovery, and reintubation. Conventional bedside predictors have limited accuracy; therefore, ultrasound-based assessment of laryngeal air column width difference (LACWD) has emerged as a promising non-invasive approach for identifying airway compromise before extubation. Objective: To evaluate the predictive value of pre-extubation LACWD measurement for identifying post-extubation upper airway obstruction and extubation outcome among pediatric intensive care unit patients. Methods: A prospective observational study was conducted among mechanically ventilated pediatric ICU patients fulfilling extubation readiness criteria at University of Child Health Sciences, The Children's Hospital Lahore. Pre extubation laryngeal ultrasonography was performed to calculate LACWD. Patients were monitored after extubation for upper airway obstruction, stridor, extubation failure, and need for reintubation. Results: Patients who developed post-extubation airway obstruction demonstrated significantly lower mean LACWD values compared with successful extubation patients (p<0.001). Reduced LACWD showed significant association with extubation failure, prolonged ventilation duration, and longer ICU stay. Receiver operating characteristic analysis demonstrated clinically useful predictive performance of LACWD for identifying patients at increased risk of airway obstruction. Conclusion: Pre-extubation LACWD measurement represents a valuable bedside ultrasound parameter for predicting post-extubation upper airway obstruction in pediatric ICU patients. Its incorporation into extubation assessment may improve risk stratification and reduce avoidable extubation failure.