Endotracheal Tube Leak Pressure and Tracheal Lumen Size in Swine

Finholt, David A.; Audenaert, Steven M.; Stirt, Joseph A.; Marcella, Kenneth L.; Frierson, Henry F.; Suddarth, Larry T.; Raphaely, Russell C.

doi:10.1213/00000539-198606000-00017

Cited by 13 publications

(9 citation statements)

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“…Despite an absent air leak, 23 of 28 patients (82.1%) successfully extubated. We did not administer a neuromuscular blocking agent to patients in order to obtain the ALT, therefore higher ALT pressures may be associated with the lack of complete muscle paralysis (16, 36-40). This may explain why higher ALT pressures in this cohort did not correlate with a greater risk for post-extubation stridor, airway compromise or the need for reintubation.…”

Section: Discussionmentioning

confidence: 99%

The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients

Wratney

Benjamin

Slonim

et al. 2008

Pediatric Critical Care Medicine

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Objective: Endotracheal tube air leak pressures (ALT) are used to predict post-extubation upper airway compromise such as stridor, upper airway obstruction, or risk of reintubation. To determine if the absence of an endotracheal tube air leak (ALT ≥ 30 cm H 2 O) measured during the course of mechanical ventilation predicts extubation failure in infants and children.Design: Prospective, blinded cohort. Setting:Multidisciplinary pediatric intensive care unit of a university hospital. Patients: Patients age ≤ 18 years and intubated ≥ 24 hoursInterventions-The pressure required to produce an audible endotracheal tube air leak was measured within 12 hours of intubation and extubation. Unless prescribed by the medical care team, patients did not receive neuromuscular blocking agents during ALT measurements. Measurements and Main Results:The need for reintubation (i.e., extubation failure) was recorded during the 24 hour post-extubation period. Seventy-four patients were enrolled resulting in 59 observed extubation trials. The extubation failure rate was 15.3% (9/59). Seven patients were treated for post-extubation stridor. Extubation failure was associated with a longer median length of ventilation, 177 vs. 78 hours, p=0.03. Extubation success was associated with the use of postextubation non-invasive ventilation (p = 0.04).The air leak was absent for the duration of mechanical ventilation (i.e., ≥ 30 cm H 2 O at intubation and extubation) in ten patients. Absence of the air leak did not predict extubation failure (negative predictive value, NPV 27%, 95% CI 6% to 60%). The ALT was ≥ 30 cm H 2 O prior to extubation in 47% (28/59) of patients yet 23 patients extubated successfully (NPV 18%).Conclusions: An endotracheal tube air leak pressure ≥ 30 cm H 2 O measured in the non-paralyzed patient prior to extubation or for the duration of mechanical ventilation was common and did not predict an increased risk for extubation failure. Pediatric patients who are clinically identified as candidates for an extubation trial but do not have an endotracheal tube air leak may successfully tolerate removal of the endotracheal tube.

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Section: Discussionmentioning

confidence: 99%

The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients

Wratney

Benjamin

Slonim

et al. 2008

Pediatric Critical Care Medicine

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“…Regardless of which formula one uses to predetermine the appropriate size of endotracheal tube with which to intubate the trachea, it is more critical to confirm the fit of the tube after it is placed. 9,30 Current techniques for confirming the proper size of endotracheal tube in children and adults include the “leak test.” This test evaluates for a leak pressure around an endotracheal tube in place. The “leak” pressure is defined as the inspiratory pressure needed to cause an audible escape of gas around the endotracheal tube.…”

Section: Discussionmentioning

confidence: 99%

“…Because different anesthetic techniques may affect the presence of an air leak around an endotracheal tube, strict standardization of the anesthetic technique was used 9 :…”

Section: Methodsmentioning

confidence: 99%

“… 1) All patients were paralyzed at intubation. 2) Halothane was the anesthetic agent used. 3) All tracheas were intubated with an uncuffed Mallinckrodt endotracheal tube with a Murphy eye. 4) Endotracheal tubes were placed so that the 1‐cm mark on the tube was just at the level of the patient's vocal cords. 5) The patient's head was in the anatomical position when testing for an air leak and not flexed, extended, or turned to either side. 6) The “proper size” of endotracheal tube was determined using the “leak test” as described by Finholt et al 9,10 This is defined as that size of tube which allows an air leak between 10 and 30 cm of H 2 O pressure. 7) The presence of an air leak around the tube was assessed by closing off the pop‐off valve of the anesthetic ventilator and allowing pressure to rise slowly until an audible leak was present. 8) An “audible leak” was one that could be heard by the ear, leaking from around the endotracheal tube. All radios, suction equipment, and room noise was eliminated during this measurement. 9) If a leak was present around the endotracheal tube at less than 10 cm of H 2 O pressure, a tube one size larger was placed and the leak was re‐evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…6) The “proper size” of endotracheal tube was determined using the “leak test” as described by Finholt et al 9,10 This is defined as that size of tube which allows an air leak between 10 and 30 cm of H 2 O pressure.…”

Section: Methodsmentioning

confidence: 99%

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