Analysis of Stridor in Patients and Impact of Emergency Tracheostomy

Aim: To analyze the various indications of emergency tracheostomy in patients presenting with Stridor. Detection of Acid-Base disorders using Arterial Blood Gas (ABG) in patients with upper airway obstruction. Its Relevance to morbidity and mortality. Impact of tracheostomy on improvement in Acid-Base Status and ventilatory status of the patient.Materials And Methods:This study was designed as a prospective cohort study of 50 patients who attended the OPD and casualty at the Department of Otorhinolaryngology in a tertiary care hospital. Thorough History, clinical examination,and relevant investigations were carried out.Arterial Blood gases were collected before tracheostomy,12 hours, and 24 hours post-procedure.Stridor was graded as mild,moderate,and severe based on the clinical grading of stridor given by Davis and Gartner.Results: In the present study, stridor was found to be more common in males when compared to females, age groups commonly affected were the 6th and 7th decade.Most of the patients presented with malignancy 44 (88%), whereas only a small proportion of patients presented with non-malignant causes 6(12%). Tobacco use,alcohol abuse,and pan use were the risk factors present in the patients in this study.The commonest Acidbase disturbance in this study group was an acute primary, uncompensated Respiratory acidosis of mild to moderate severity.Based on the clinical grading of Stridor,10(20%) patients had mild Stridor,11(22%) had moderate Stridor,and 29(58%) had severe Stridor. Based on ABG categorization, 44(88%) patients were in respiratory failure at the time of presentation in our institute,4(8%) were in impending failure, and 1(2%) patient showed no evidence of failure. Conclusion: Clinical assessment of Stridor can be occasionally misleading and can lead to a delay in the timing of tracheostomy or intubation.Respiratory failure,if allowed to progress will eventually lead to circulatory failure.Thus,the ABG analysis used in this study provided valuable information about the acid-base imbalance and respiratory status of the patient helping in the intervention.