Risk factors for post-extubation stridor in pediatric cardiac intensive care unit: a single-center retrospective study

Post-extubation stridor (PES) is a frequent and clinically significant complication among pediatric cardiac intensive care unit (PCICU) patients, particularly those with congenital heart disease (CHD). This study aimed to determine the incidence, associated risk factors, and outcomes of PES in this population. This retrospective cohort study included children aged 1 month to 18 years who underwent planned extubation after more than 24 h of mechanical ventilation in the PCICU at Chiang Mai University Hospital between July 2016 and June 2024. Demographic, clinical, and ventilatory variables were retrieved from electronic medical records. Univariable and multivariable mixed-effects logistic regression analyses were performed to identify independent predictors of PES. Among 494 extubation episodes from 380 children, PES occurred in 25.5% of attempts. Patients who developed PES were younger, low body weight, and had longer ventilation duration compared with those without PES. In multivariable analysis, lower body weight (OR 0.84; 95% CI, 0.73–0.97) and mechanical ventilation exceeding 7 days (OR 1.83; 95% CI, 1.04–3.23) remained significant independent predictors. PES was common among pediatric cardiac patients and was independently associated with lower body weight at extubation and prolonged mechanical ventilation. Recognition of children at higher risk may support targeted preventive strategies and improve post-extubation outcomes.