A Scoping Review of Laryngeal Edema Rating Scales for Extubated Acute Respiratory Failure Survivors.

Abstract

After extubation for acute respiratory failure (ARF), many survivors exhibit laryngeal edema. Laryngeal edema is an independent predictor of aspiration, stridor, and reintubation-events associated with morbidity, mortality, and complex hospital courses. Evaluating associations between laryngeal edema and adverse clinical outcomes requires accurate and reproducible edema rating instruments. The aims of this review were to identify existing laryngeal edema rating scales and to assess which scales, if any, are adequately designed for ARF patients. A structured search of PubMed, Web of Science, and Embase was conducted in May 2026. Covidence Scoping Review software was used for screening and tracking. Titles and abstracts were reviewed based on predefined inclusion and exclusion criteria, with full-text screening focused on studies explicitly detailing laryngeal edema assessment methods. This review was reported as per PRISMA guidelines. Thirty-five studies were included in this review. Most studies (n = 22) utilized subjective binary (present/absent) classifications, while others (n = 13) employed ordinal rating scales. Only the Radiation Therapy Oncology Group (RTOG) scale and Patterson Edema Scale included operationally defined tools and reliability/validity testing, but they were developed for head and neck cancer patients. In studies of ARF patients, edema scales were purpose built and lacked clear operational definitions. No laryngeal edema instruments have undergone formal psychometric development and testing for use in the post-extubation ARF patient population. Subsequent research should determine if any existing scales can be employed with reliability and validity in the ARF patient population or if a new instrument should be developed. N/A.