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Post-Extubation Stridor — RACP Adult Medicine MCQ

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ModerateRespiratoryPost-Extubation StridorRACP Adult Medicine

A 45-year-old man post-extubation in ICU develops stridor and increased work of breathing. He has upper airway oedema from prolonged intubation. SpO₂ is 94% on 6L nasal prongs. ABG shows PaCO₂ 38 mmHg, pH 7.42. What is the most appropriate ventilatory support?

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Correct answer: B — High-flow nasal oxygen

Post-extubation stridor with upper airway oedema but no hypercapnia is best managed with high-flow nasal oxygen (HFNO). HFNO provides humidified heated oxygen at 40–60 L/min, generates low-level PEEP (3–5 cmH₂O), reduces dead space, and provides a nasopharyngeal reservoir. Nebulised adrenaline and IV dexamethasone should also be given for upper airway oedema.

Reference: eTG Respiratory – 2024 – Post-Extubation; FLORALI Trial