Diagnostic efficacy of sonographic measurement of laryngeal air column width difference for predicting the risk of post-extubation stridor: A meta-analysis of observational studies

Wen-Wen Tsai; Kuo-Chuan Hung; Yen-Ta Huang; Chia-Hung Yu; Chien-Hung Lin; I-Wen Chen; Cheuk-Kwan Sun

doi:10.3389/fmed.2023.1109681

Diagnostic efficacy of sonographic measurement of laryngeal air column width difference for predicting the risk of post-extubation stridor: A meta-analysis of observational studies

Front Med (Lausanne). 2023 Jan 19:10:1109681. doi: 10.3389/fmed.2023.1109681. eCollection 2023.

Authors

Wen-Wen Tsai¹, Kuo-Chuan Hung^{2

3}, Yen-Ta Huang⁴, Chia-Hung Yu³, Chien-Hung Lin³, I-Wen Chen⁵, Cheuk-Kwan Sun^{6

7}

Affiliations

¹ Department of Education, Chi Mei Medical Center, Tainan City, Taiwan.
² School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung City, Taiwan.
³ Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
⁴ Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan City, Taiwan.
⁵ Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan.
⁶ Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
⁷ School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan.

Abstract

Background: This meta-analysis aimed at assessing the diagnostic accuracy of ultrasound-measured laryngeal air column width difference (ACWD) in predicting post-extubation stridor (PES) in intubated adult patients.

Methods: We searched the Medline, Cochrane Library, EMBASE, and Google scholar databases from inception to October, 2022 to identify studies that examined the diagnostic accuracy of ACWD for PES. The primary outcome was the diagnostic performance by calculating the pooled sensitivity, specificity, and area under the curve (AUC). The secondary outcomes were the differences in ACWD and duration of intubation between patients with and without PES.

Results: Following literature search, 11 prospective studies (intensive care setting, n = 10; operating room setting, n = 1) involving 1,322 extubations were included. The incidence of PES among the studies was 4-25%. All studies were mixed-gender (females: 24.1-68.5%) with sample sizes ranging between 41 and 432. The cut-off values of ACWD for prediction of PES varied from 0.45 to 1.6 mm. The pooled sensitivity and specificity of ACWD for PES were 0.8 (95% CI = 0.69-0.88, I ²: 37.26%, eight studies) and 0.81 (95% CI = 0.72-0.88, I ²: 89.51%, eight studies), respectively. The pooled AUC was 0.87 (95% CI = 0.84-0.90). Patients with PES had a smaller ACWD compared to those without PES (mean difference = -0.54, 95% CI = -0.79 to -0.28, I ²: 97%, eight studies). Moreover, patients with PES had a longer duration of tracheal intubation than that in those without (mean difference = 2.75 days, 95% CI = 0.92, 4.57, I ²: 90%, seven studies).

Conclusion: Ultrasound-measured laryngeal ACWD showed satisfactory sensitivity and specificity for predicting PES. Because of the limited number of studies available, further investigations are needed to support our findings.

Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022375772.

Keywords: air column width difference; meta-analysis; post-extubation stridor; tracheal extubation; ultrasound.

Publication types

Systematic Review