Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis

Ochoa, Minerva Lazos; Marín, María del Carmen; Frutos‐Vivar, Fernando; Gordo, Federico; Latour-Pérez, Jaime; Calvo, Enrique; Esteban, Andrés

doi:10.1007/s00134-009-1501-9

Cited by 113 publications

(62 citation statements)

References 23 publications

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“…7 A meta-analysis of the cuff-leak test has shown moderate accuracy of the test for predicting postextubation stridor and low accuracy for predicting the need for re-intubation. 51 In the difficult airway, however, where the pretest probability of extubation failure is greater, the cuff-leak test may still provide valuable clinical information to assist in the decision of whether to proceed with extubation.…”

Section: Decision To Extubatementioning

confidence: 99%

Tracheal ExtubationDiscussion

Artime¹,

Hagberg²

2014

Respir Care

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Tracheal extubation in both the critical care and anesthesia setting is not only an important milestone for patient recovery, but also a procedure that carries a considerable risk of complication or failure. Mechanical ventilation is associated with significant complications that are time-dependent in nature, with a longer duration of intubation resulting in a higher incidence of complications, including ventilator-associated pneumonia, and increased mortality. Extubation failure and subsequent re-intubation are associated with an overall increase in the duration of mechanical ventilation, increased mortality, a greater need for tracheostomy, and higher medical costs. These risks demand that the process of extubation be managed by practitioners with a detailed understanding of the causes of extubation failure and the potential complications. A pre-established extubation plan with considerations made for the possible need for re-intubation is of the utmost importance.

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Section: Decision To Extubatementioning

confidence: 99%

Tracheal ExtubationDiscussion

Artime¹,

Hagberg²

2014

Respir Care

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“…The SBT is presently the major diagnostic tool to determine if patients can be successfully extubated [1], and recent recommendations have been made to further increase the likelihood of successful extubation [8][9][10][11][12][13][14][15]. Nonetheless, extubation failure-defined as the need for ventilatory support or death within 48 h following extubation (adapted from [1])-is still prevalent, with reported reintubation rates of up to 19% [1,16,17] and 5-24% for rescue therapy with non-invasive ventilation (NIV) [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…The recommended approaches to evaluate the likelihood of successful extubation rely on objective criteria assessed by the clinician [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Little emphasis has been placed so far on the patients' subjective evaluation of the potential to sustain autonomous breathing, which might be influenced by psychological factors as well as the perceived work of breathing.…”

Section: Introductionmentioning

confidence: 99%

Patients’ prediction of extubation success

et al. 2010

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Purpose: The spontaneous breathing trial (SBT)-relying on objective criteria assessed by the clinician-is the major diagnostic tool to determine if patients can be successfully extubated. However, little is known regarding the patient's subjective perception of autonomous breathing. Methods: We performed a prospective observational study in 211 mechanically ventilated adult patients successfully completing a SBT. Patients were randomly assigned to be interviewed during this trial regarding their prediction of extubation success. We compared post-extubation outcomes in three patient groups: patients confident (confidents; n = 115) or not (nonconfidents; n = 38) of their extubation success and patients not subjected to interview (control group; n = 58). Results: Extubation success was more frequent in confidents than in non-confidents (90 vs. 45%; p \ 0.001/positive likelihood ratio = 2.00) or in the control group (90 vs. 78%; p = 0.04). On the contrary, extubation failure was more common in non-confidents than in confidents (55 vs. 10%; p \ 0.001/ negative likelihood ratio = 0.19). Logistic regression analysis showed that extubation success was associated with patient's prediction [OR (95% CI): 9.2 (3.74-22.42) for confidents vs.non-confidents] as well as to age [0.72 (0.66-0.78) for age 75 vs. 65 and 1.31 (1.28-1.51) for age 55 vs. 65]. Conclusions: Our data suggest that at the end of a sustained SBT, extubation success might be correlated to the patients' subjective perception of autonomous breathing. The results of this study should be confirmed by a large multicenter trial.

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“…The performance of a cuff leak test is an important part of the process and at this time a 200-ml leak is considered the minimal amount to extubate. 39,61 Total subaxial reconstruction should be reserved for complex pathology that involves the entire subaxial cervical spine. When neural compression, instability, or deformity involves all of the segments the decision to operate at every level is straightforward.…”

Section: Discussionmentioning

confidence: 99%

Total subaxial reconstruction

Traynelis¹

2010

SPI

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Object. Certain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the postoperative outcomes following surgery.Methods. The author performed a review of data prospectively collected in 27 consecutive patients undergoing complete anterior decompression and reconstruction of the anterior cervical spine and followed by posterior instrumented arthrodesis with or without decompression.Results. There were 16 men and 11 women whose mean age was 59 years (range 35-86 years). The minimum follow-up was 12 months and the mean follow-up period for all patients was 26 months. One patient underwent C2-7 surgery, and in all others the procedure crossed the cervicothoracic junction.Following surgery patients remained intubated for an average of 3.3 days (range 1-22 days). The mean hospital length of stay was 11 days (range 3-45 days). One patient died 6 weeks following an uneventful surgery. Pneumonia developed in 5 patients, 1 patient experienced a minor pulmonary embolism, and 2 patients had posterior wound infections. No patient was neurologically worse following surgery. A single patient presented with a C-8 radiculopathy 6 weeks after surgery. At final follow-up no patient complained of dysphagia when specifically questioned about this potential problem. In all patients solid fusions developed at each treated levels. Preoperatively the mean sagittal Cobb angle was 15.4° (kyphosis) and the postoperative mean angle was −10.9° (lordosis) representing a total average correction of over 25° (p < 0.0001). The mean preoperative Neck Disability Index was 27.6; this score decreased to 15.5 (p = 0.0008) postoperatively. The mean pre-and postoperative visual analog scale neck pain scores were 6.0 and 2

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Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis

Abstract: A positive cuff-leak test (absence of leak) should alert the clinician of a high risk of upper airway obstruction.

Cited by 113 publications

References 23 publications

Tracheal ExtubationDiscussion

Tracheal ExtubationDiscussion

Patients’ prediction of extubation success

Total subaxial reconstruction

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