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Background Cuff leak test (CLT) has been used widely to assess upper airway patency before extubation but with low positive predictive value. Aim To assess the diagnostic accuracy of the airway column width ratio (ACWR) in predicting postextubation stridor (PES). Patients and methods 50 Patients who intubated &amp;gt;24 hours were observed for postextubation stridor and reintubation. Laryngeal ultrasound was done to measure the ACW with ETT cuff deflated immediately after intubation and 3–4 h before extubation. Cuff leak test was done. Results Fifty patients were included with mean age 58 ± 14.71 years, 68% were males and 32% were females. PES developed in 8% of patients. There was highly statistically significant difference between both groups regarding ACW before extubation and ACW ratio (p-value =0.006 and 0.000 respectively). The mean ACW ratio in stridor group (0.79 ± 0.03) was significantly lower than in non-stridor group (0.94 ± 0.04). Reintubation was higher in stridor group (100%) than non-stridor group (23.9%), P = 0.001. There was statistically significant higher duration of mechanical ventilation in stridor group (7.50 ± 0.58 vs. 4.23 ± 2.50 days, P = 0.013). A cut off point of ACW ratio ≤0.81 has a sensitivity 100% and Specificity 100%. Conclusion ACW showed excellent utility in prediction of patients with PES. Air column width ratio of ≤ 0.81 was a good predictor of PES.

Laryngeal air column width ratio in predicting postextubation stridor