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At least 19 recordsLinked to original sources
PubMed1998

Stridor in the neonate and infant. Implications for the paediatric anaesthetist. Prospective description of 155 patients with congenital and acquired stridor in early infancy.

One hundred-and-fifty-five neonates and infants up to the sixth month of postnatal age were investigated to reveal the cause of clinically relevant stridor. In 100 patients congenital stridor was found, in 55 children the stridor was considered to be acquired. A curled, soft epiglottis, almost synonymously used with the diagnosis of congenital stridor, was found in 7% only, indicating different methods of investigation and different selection of patients compared to previous years. In acquired stridor the majority of infants showed laryngeal and tracheal trauma, mostly due to the use of too large tracheal tubes.

Airway Obstruction↗
PubMed2003

Amphotericin-induced stridor: a review of stridor, amphotericin preparations, and their immunoregulatory effects.

BACKGROUND: Various adverse effects have been reported with the use of amphotericin B. The respiratory adverse effects include dyspnea, tachypnea, bronchospasm, hemoptysis, and hypoxemia. Stridor has not been previously reported with the use of amphotericin B. OBJECTIVE: To review the mechanism of action and reports of respiratory adverse effects for amphotericin B, the liposomal preparations of amphotericin B, and the differential diagnosis of stridor. DATA SOURCES: A MEDLINE search from 1966 to 2002 was performed to review the current literature for possible mechanisms and immunoregulatory effects related to the infusion of amphotericin B. RESULTS: Amphotericin B has been shown to increase tumor necrosis factor alpha (TNF-alpha) concentrations in macrophages. In addition, it induces prostaglandin E2 synthesis and increases the production of interleukin 1beta (IL-1beta) in mononuclear cells. The immunoregulatory effects of amphotericin B include increases in apoptosis, production of monocyte chemoattractant protein 1, superoxide anion, nitric oxide, and intercellular adhesion molecule 1 expression. CONCLUSIONS: Amphotericin B induces the production of TNF-alpha, interferon-gamma, and IL-1beta, which may potentiate its toxic effects. Some liposomal preparations induced lower levels of TNF-alpha and nitric oxide and may be useful in patients unable to tolerate amphotericin B deoxycholate.

Acute Disease↗
PubMed2003

Laryngeal dystonia causing inspiratory stridor in children with cerebral palsy.

SUMMARY: OBJECTIVE To present three cases of inspiratory stridor caused by laryngeal dystonia (LD) in children with cerebral palsy (CP), one of whom is being treated by periodic botulinum toxin type A (BTX) injection into a vocalis muscle, thereby avoiding tracheostomy. STUDY DESIGN Case series. RESULTS AND CONCLUSIONS Laryngeal dystonia was diagnosed in three children with CP who presented with inspiratory stridor associated with generalized dystonia, all of whom were thought previously to have had laryngomalacia. The inspiratory stridor was severe enough in one patient that a tracheostomy was planned. In common with the movement disorder of generalized dystonia, the inspiratory stridor caused by LD was present in our patients when they were awake, worse when they were excited or agitated, diminished when they were awake and calm, and absent when they were asleep. Although there is overlap between the symptoms of LD and laryngomalacia (and other structural causes of upper airway obstruction) in children with CP, structural causes result in inspiratory stridor that is often persistent when patients are awake and relaxed or when they are asleep. Fiberoptic laryngoscopy in an awake patient with LD reveals vocal cord adduction in inspiration causing inspiratory stridor in association with generalized dystonia. Baclofen and gabapentin used together relieved the inspiratory stridor and improved the generalized dystonia of two patients, confirming the clinical diagnosis of LD, but for the last 2 years the third patient (the one with the most severe inspiratory stridor) also has required a periodic BTX injection into a vocalis muscle (the major vocal cord adductor) to relieve her inspiratory stridor, alternating the side of injection. Her mother considers this is a small price to pay to avoid tracheostomy. This is the first report of LD causing inspiratory stridor in patients with CP and the first reported use of BTX injection into a vocalis muscle for relief of inspiratory stridor due to LD in a child.

Botulinum Toxins, Type A↗
PubMedDate not supplied

Stridor in a 6-week-old infant caused by right aortic arch with aberrant left subclavian artery.

BACKGROUND: Persistent infant stridor, seal-like cough, and difficulty feeding can be the initial signs of right aortic arch with an aberrant left subclavian artery. This congenital cardiovascular abnormality results in the development of a vascular ring that encircles the trachea and esophagus. METHODS: A case report is presented that describes the evaluation and care of a 6-week-old male infant whose condition was diagnosed as right aortic arch and aberrant left subclavian artery after he was brought to the family practice clinic with a history of persistent stridor. This case report involved a patient seen in the author's outpatient clinic during a well-child check. Data were obtained from the patient's medical record and review of his radiologic diagnostic tests. MEDLINE and Index Medicus literature searches were conducted for the years 1966 to the present, using the key words "stridor" and "vascular ring," with cross-references for earlier articles. RESULTS AND CONCLUSIONS: Persistent or recurrent stridor associated with feeding difficulties should prompt an investigation for a vascular ring. In general, an anteroposterior and lateral neck radiograph and a posteroanterior and lateral chest radiograph are usually the initial diagnostic tests to evaluate stridor. Persistent stridor and new-onset regurgitation of formula in a 6-week-old infant prompted an escalation of the patient's workup to include a barium swallow, which subsequently showed compression of the esophagus caused by a vascular ring. In some cases direct observation with a laryngoscope or bronchoscope might be necessary to determine the cause of stridor. Indications for hospitalization of patients with stridor include stridor at rest, dyspnea, actual or suspected epiglottis, repeatedly awakening from sleep with stridor, a history of rapid progression of symptoms, toxic appearance, and apneic or cyanotic episodes. The primary care provider should be familiar with the evaluation and management for patients with the complaint of persistent or recurrent stridor.

Aorta, Thoracic↗
PubMed2000

Stridor and death in multiple system atrophy.

Patients with multiple system atrophy (MSA) have a mean survival of 8 to 10 years. Nocturnal stridor has been considered a poor prognostic feature. We analyzed demographic, clinical, and polysomnographic data and obtained follow-up information from 42 patients with MSA (30 with follow-up data) seen in a Sleep Disorders Center. Group I consisted of 17 patients with nocturnal stridor, including seven with daytime stridor. Group II consisted of 25 patients without stridor. Analysis of survival curves of 30 patients with follow-up information showed a significantly shorter survival from the sleep evaluation, but not from disease onset, for patients with stridor compared with those without. Nine of 11 patients with stridor died a median of 2 years from presentation and the only two survivors had undergone tracheostomy. Patients with daytime stridor and immobile vocal cords had especially poor prognoses. However, two of four patients with tracheostomies also died, as did six of 19 without stridor. We postulate that central hypoventilation and its complications may have been responsible for many of these other deaths. We conclude that stridor does carry a poor prognosis in patients with MSA but that there are also other causes of death. We recommend consideration of tracheostomy for patients with MSA who have stridor, but also assessment for central hypoventilation and appropriate management if it is present.

Aged↗
PubMed2003

Laryngeal stridor in multiple system atrophy.

The purpose of this study was to elucidate the clinical features of laryngeal stridor in 104 patients with multiple system atrophy (MSA) and to predict the hazard risk. Stridor was observed in 36 patients. It occurred in the first year of the disease in 10 cases, and 69% of the cases were diagnosed with stridor within the first 4 years. Dysphagia and hoarseness had a statistically higher frequency in the stridor group, and the onset period of these elements correlated with the onset of stridor. A follow-up study of survival probability was carried out in 83 patients. The median survival period in the stridor group (33 cases) and the non-stridor group (50 cases) was 8.0 and 9.0 years, respectively. Treatment for stridor decreased the relative risk from 2.998 to 0.147. Laryngeal stridor is a common and early clinical symptom in MSA. Early treatment for stridor is advisable to reduce mortality.

Adult↗
PubMed1998

Post-extubation stridor: risk factors and outcome.

Post-extubation stridor is a potential complication of endotracheal intubation. The incidence, risk factors, and outcome in adult patient populations are poorly defined. It was our clinical impression that the occurrence of post-extubation stridor in our medical intensive care unit was more frequent than generally reported. We therefore monitored all intubated patients to determine the incidence of post-extubation stridor and to identify any predisposing factors. All adult patients requiring endotracheal intubation and medical intensive care admission were prospectively observed over a 5-month period in a university-affiliated medical intensive care unit. Sixty-seven patients requiring intubation and medical intensive care admission were evaluated. Twenty-two patients were excluded from analysis because no extubation was attempted. The remaining 45 patients were divided into two groups: 8 with and 37 without post-extubation stridor. Of the parameters analyzed, cuff pressure, treatment with corticosteroids at the time of extubation, and the presence of a primary neurologic process necessitating intubation differed significantly between groups. Six of the 8 patients who developed post-extubation stridor required reintubation. Four of these patients were subsequently successfully extubated, one required tracheostomy, and one patient died after a 2-week deteriorating clinical course. The incidence of significant stridor in our population was 17.8%. Medical management was successful in the majority of patients with post-extubation stridor. Routine tracheostomy following a single episode of post-extubation stridor is not indicated. Further investigation regarding risk factors and a placebo-controlled trial evaluating the efficacy of systemic corticosteroids before extubation in individuals at risk for developing post-extubation stridor are needed.

Aged↗
PubMed1990

Stridor and gastroesophageal reflux in infants.

A relation was found between persistent stridor and gastroesophageal reflux in seven infants, aged 6 weeks to 6 months. Stridor began at 11 days to 2 months of age, and four of the seven infants had transient hypercarbia on at least one occasion before study. Only one had a history of frequent vomiting; three had recurrent pneumonia. Midesophageal pH, chest and abdominal movement, exhaled carbon dioxide partial pressure, and heart rate of six of the infants were recorded for 4 to 12 hours as they slept. Esophageal pH of the seventh infant was recorded for 24 hours. In the six completely studied infants, there were persistent increases of greater than 10 mm Hg in exhaled carbon dioxide level (three infants), of greater than 10 breaths per minute in respiratory rate (four infants), and in retractions and stridor (six infants) 5 to 20 minutes after onset of reflux. Stridor improved with medical management in 48 hours (five of five infants) and disappeared in 3 weeks (three of five infants) to 2 months (one of five infants). One of these medically treated infants subsequently was treated by Nissen gastric fundoplication because of a recurrence of persistent and severe stridor. Three infants had antireflux surgery, and in two of these stridor disappeared in 48 hours. In the third infant stridor disappeared 3 weeks after surgery. Based on this experience, reflux occasionally causes stridor, probably because of acute inflammation of the upper airway. If structural anomalies are ruled out, infants with severe stridor should be examined for gastroesophageal reflux.

Esophagus↗
PubMed2000

Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults.

BACKGROUND: Post-extubation stridor may prolong length of stay in the intensive care unit, particularly if airway obstruction is severe and re-intubation proves necessary. Corticosteroids, however, may be associated with adverse effects ranging from hypertension to hyperglycemia, and a more systematic assessment of the efficacy of this therapy is indicated prior to widespread adoption of this practice OBJECTIVES: To determine whether corticosteroids are effective in preventing or treating post-extubation stridor in critically ill infants, children, or adults. SEARCH STRATEGY: Controlled trials were identified through MEDLINE, EMBASE and CINAHL. Bibliographies of all identified trials were examined, and authors of included trials were contacted to confirm the methodology and identify other potentially relevant trials. SELECTION CRITERIA: Any randomized controlled trial that compared administration of corticosteroids by any route with placebo in infants, children, or adults receiving mechanical ventilation via an endotracheal tube in an intensive care unit. DATA COLLECTION AND ANALYSIS: Data from the included studies were extracted independently by two reviewers. The main outcome was the rate of tracheal re-intubation after extubation. The incidence of stridor was examined as a secondary outcome. Subgroup analysis was predetermined to compare preventative use of steroids before extubation and therapeutic use following extubation. Neonates, pediatric patients, and adults were compared separately. A random effects model was used throughout. Methodologic quality of trials was assessed independently by the two reviewers. MAIN RESULTS: Of 251 studies identified, only seven met the criteria for inclusion; three in adults, two in neonates, three in children. All but one examined use of steroids for the prevention of post-extubation stridor; the remaining one concerned treatment of existing post-extubation stridor in children. Patients were drawn from heterogeneous medical/surgical populations. Dexamethasone given intravenously at least once prior to extubation was the most common steroid regimen utilized (uniformly in neonates and children). Prophylactic intervention tended to decrease re-intubation rates among neonates and children, but did not reach statistical significance (neonates RR=0.1, 95% CI 0.01, 1.68; children RR=0.49, 95% CI 0.01, 19.65). Post-extubation stridor was reduced in children (n=216: RR=0.53, 95% CI 0.28, 0.97) but not in neonates. In the neonatal studies, a lower re-intubation rate was seen only in high risk patients treated with multiple doses of steroids around the time of extubation. In three adult studies (total n=1047), no difference in post-extubation stridor (RR=0.86, 95% CI 0.57, 1.30) or re-intubation rates (RR=0.95, 95% CI 0.52, 1.72) was detected. Side effects were reported seldomly and could not be aggregated. REVIEWER'S CONCLUSIONS: In neonates, there is a trend towards a reduced incidence of re-intubation in neonates receiving prophylactic dexamethasone prior to extubation. In children, prophylactic administration of dexamethasone prior to elective extubation reduces the incidence of post-extubation stridor, but the evidence is insufficient to conclude that rates of re-intubation are reduced. In adults, corticosteroids do not appear to reduce the need for re-intubation.

Adrenal Cortex Hormones↗
PubMed2000

Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation.

BACKGROUND: The purpose of this study was to determine the predictive value of an endotracheal tube cuff leak for the development of postextubation stridor and the need for reintubation. STUDY DESIGN: Consecutive trauma patients who required intubation at a level I trauma center from July 1997 to July 1998 were studied prospectively. Pediatric patients and those who did not meet the standard weaning protocol criteria established by the Division of Trauma and Surgical Critical Care were excluded. Injury Severity Score, endotracheal tube size, reason for intubation, and the number of days intubated before the initial extubation attempt were recorded. At the time of extubation, the difference in exhaled tidal volume from before to after endotracheal tube cuff deflation was calculated. This number was then divided by the exhaled tidal volume before cuff deflation and was recorded as the percent cuff leak. Patients were followed for 24 hours after extubation for the development of stridor or need for reintubation. Statistical analysis to compare subgroups of patients was performed using ANOVA with Scheffé post hoc analysis. RESULTS: Among the 110 patients analyzed, the most common reason for intubation was closed-head injury. Seven patients (6.4%) developed stridor alone and had a mean cuff leak of 5 8 mL (8.4% of tidal volume before cuff deflation). Six patients (5.5%) experienced stridor that required reintubation and had a mean cuff leak of 68 mL (9.2% of tidal volume before cuff deflation). Patients who developed stridor or needed reintubation had been intubated for a significantly greater length of time than those not developing stridor or requiring reintubation (2.6 versus 3.0 days, p < 0.001). There were no differences in Injury Severity Score, endotracheal tube size, or reason for intubation between these groups. CONCLUSIONS: A cuff leak of less than 10% of tidal volume before cuff deflation is useful in identifying patients at risk for stridor or reintubation (96% specificity). It appears that the amount of cuff leak decreases after intubation for more than 3 days, increasing the risk of stridor and need for reintubation. This information may be helpful in identifying those patients who need treatment for laryngotracheal edema, ie, use of steroids or anesthesia during extubation, the efficacy of which remains to be determined.

Craniocerebral Trauma↗
PubMedDate not supplied

Endoscopic findings in children with stridor.

UNLABELLED: Congenital and acquired airway diseases are responsible for upper respiratory distress and stridor in children. In neonatal intensive care units, we have seen increased survival in premature babies, but also a high incidence of airway complications related to intubation, which present as stridor. AIM: To review endoscopic findings in children with stridor. STUDY DESIGN: a cross-sectional cohort study. METHODS: A retrospective analysis was done of 55 cases of children with stridor who underwent endoscopic exams, between January 1997 and December 2003. RESULTS: 69% were aged below one year. The main indications for endoscopy were post-extubation stridor (63.63%) and evaluation of neonatal stridor (21.82%). Many associated diseases were seen, including lung diseases (60%), neurological condition (45.4%), and GERD (40%). The main endoscopic findings and indications for tracheotomy were subglottic stenosis (27.27%) and airway inflammatory process (21.82%) occurring in children under five years old. Congenital disorders were more frequent in children under age one year. CONCLUSION: Neonatal stridor has many causes; those related to tracheal intubation are more frequent in hospitals that treat more complex diseases. Pediatricians and otorhinolaryngologists should know the main causes of stridor and perform detailed clinical evaluations to determine case severity. The endoscopic examination, must be meticulous.

Airway Obstruction↗
PubMed2002

Corticosteroids for the prevention of reintubation and postextubation stridor in pediatric patients: A meta-analysis.

OBJECTIVE: To determine whether corticosteroids are effective in preventing or treating postextubation stridor and in reducing the need for subsequent reintubation of the trachea in critically ill infants and children. DESIGN: Meta-analysis of published randomized controlled trials. DATA SOURCES: References of each trial from a MEDLINE search were reviewed, and experts in the field were contacted. STUDY SELECTION: Any randomized controlled trial comparing the administration of corticosteroids with placebo on the prevalence of reintubation or postextubation stridor in infants or children receiving mechanical ventilation via an endotracheal tube in an intensive care unit. DATA EXTRACTION: Data extraction and methodologic quality assessment were assessed independently by two reviewers. DATA SYNTHESIS: Six controlled clinical trials met the criteria for inclusion; three trials pertain to neonates and three to children. Five trials examined the use of steroids for the prevention of reintubation (four of these evaluated postextubation stridor specifically); one trial examined the use of steroids to treat existing postextubation stridor in children. There was a nonsignificant trend toward a decreased rate of reintubation in all subjects when prophylactic steroids were used (n = 376, relative risk [RR] = 0.34, 95% confidence interval [CI] = 0.05-2.33). Prophylactic use of steroids reduced postextubation stridor in the pooled studies (n = 325, RR = 0.50, 95% CI = 0.28-0.88). In young children, there were significant reductions of postextubation stridor with preventive treatment (n = 216, RR = 0.53, 95% CI = 0.28-0.97), and a trend toward less stridor was observed in neonates (n = 109, RR = 0.42, 95% CI = 0.07-2.32). There was a nonsignificant trend toward a reduced reintubation rate when steroids were used to treat existing upper airway obstruction requiring reintubation (RR = 0.55, 95% CI = 0.17-1.78). Side effects were seldom reported and could not be evaluated. CONCLUSIONS: Prophylactic administration of dexamethasone before elective extubation reduces the prevalence of postextubation stridor in neonates and children and may reduce the rate of reintubation.

Journal Article↗
PubMed2006

[Etiology of laryngeal stridor in neonates: analysis of 16 cases].

OBJECTIVE: To reduce misdiagnosis and explore etiology of laryngeal stridor in neonates. METHODS: Sixteen neonates with laryngeal stridor were reviewed. All the patients were examined with CT scan for larynx and lungs and some were examined with laryngoscopy. Laboratory examination and chromosome analysis were also done in all or some patients. RESULTS: All the 16 neonates were diagnosed before admission as congenital simple laryngeal stridor in other hospitals. Of the 16 neonates with laryngeal stridor, 5 (31%) had thyroglossal ductal cyst, 1 (6%) neonate with cri du chat (5p(-)) syndrome, 2 (13%) neonates with Pierre-Robin syndrome and the rest 8 (50%) were suspected of congenital simple laryngeal stridor. CONCLUSION: Neonates with laryngeal stridor are easily misdiagnosed; neonatal thyroglossal duct cyst is one of common causes. The diagnosis for a congenital simple laryngeal stridor should be carefully made excluding the possibility of related diseases. The authors recommend that laryngoscopy and CT scan for larynx should be performed in the neonates with laryngeal stridor.

Diagnostic Errors↗
PubMed1999

Diagnostic value of infantile stridor: a perceptual test.

INTRODUCTION: stridor is the most common presenting symptom of pediatric airway obstruction, yet its value in clinical diagnosis is undetermined. The purpose of this study was to determine what diagnostic information was available to clinicians based entirely on listening to infantile stridor. METHOD: ten taped samples of stridor and corresponding clinical summaries were independently scored by Pediatric Otolaryngologists and their trainees. Respondents were asked to score the 'perceived' severity of the stridor based on their aural perception. Participants were recruited by an advertisement on the Internet Pediatric Otolaryngology forum. Thirty-eight consultants and 22 trainees responded. The responses were compared to known outcomes in the ten patients presented. RESULTS: listening to stridor in isolation resulted in respondents performing at the level of chance when their score of 'perceived' severity was compared to the known clinical outcome. When the clinical summaries (of the same patients) were scored, the level of performance significantly improved (P < 0.001). There was no difference in the level of performance when responses of trainees were compared with consultants, although there was a trend towards improved performance by the consultants. CONCLUSION: the importance of infantile stridor judged in isolation is of limited diagnostic value. Clinical information contributes significantly to the rating of stridor severity. The combination of both clinical and auditory information will likely improve diagnostic acumen.

Clinical Competence↗