Intra-individual Variation of the Cuff-Leak Test as a Predictor of Post-Extubation Stridor

Gros, Antoine; Holzapfel, L.; Marqué, Sophie; Pérard, L.; Demingeon, G.; Piralla, Bonavie; Gaillard, Sandrine; Tchénio, Xavier

doi:10.4187/respcare.01527

Cited by 26 publications

(31 citation statements)

References 19 publications

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“…Even though Gros et al 9 reported a sensitivity of 86% in their study results, the wide confidence intervals (95% CI 42-100%), and the results of other studies point to an overall low sensitivity of cuff leak volumes in detecting post-extubation stridor. While there is currently no evidence that delaying extubation of patients with a positive CLT improves outcomes, the following considerations can help to reduce the incidence of extubation failure and improve the success rate of reintubation attempts…”

Section: See the Original Study On Page 2026mentioning

confidence: 61%

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The Cuff Leak Test: Does It “Leak” Any Information?

Argalious

2012

Respir Care

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Section: See the Original Study On Page 2026mentioning

confidence: 61%

“…9 They performed the CLT (as proposed by Miller and Cole) immediately after intubation (T0) and before extubation (T1) to evaluate the differences in cuff leak: ⌬CLT ϭ CLT1 -CLT0. A positive CLT was defined as ⌬CLT Ͻ 0 mL, according to the receiver-operating characteristic curve.…”

mentioning

confidence: 99%

The Cuff Leak Test: Does It “Leak” Any Information?

Argalious

2012

Respir Care

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“…One significant problem of the cuff‐leak test is that it is a ‘snap shot’ of a dynamic process – laryngeal oedema. The potential variability in laryngeal oedema over time may confound the results of standard pre‐extubation cuff‐leak testing . It is, therefore, a test that should be used only as part of a dynamic management plan, including other tests such as visualisation of the larynx, as well as a planned re‐intubation protocol.…”

Section: Resultsmentioning

confidence: 99%

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

et al. 2016

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Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment. The findings in the section on Intensive Care and Emergency Medicine reinforce the importance of good airway management in the critical care environment and, in particular, the need for appropriate guidelines to improve patient safety. This narrative review focuses on strategies for safe extubation of the trachea for patients with potentially difficult upper airway problems in the intensive care unit.

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“…Patients were tested in the operating room after general anesthesia and endotracheal intubation Six respiratory cycles were observed until equalization between inspired and expired tidal volumes took place, with an acceptable error margin of 20 mL 5,14 . After adequate suctioning, the ETT cuff was then deflated and then two additional respiratory cycles were performed to allow the subject to cough.…”

Section: Clt Testing Protocolmentioning

confidence: 99%

Analysis and Temporal Evolution of Extubation Parameters for Patients Undergoing Single-Stage Circumferential Cervical Spine Surgery

et al. 2020

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Purpose: Airway obstruction after post-operative extubation is a dreaded but uncommon complication in patients undergoing circumferential cervical spine surgery (CCSS). The cuff leak test (CLT)has been utilized to assess air leak around the endotracheal tube(ETT) which may reflect airway swelling. In this prospective observational study, we analyze the temporal evolution of CLT and perioperative factors that may influence it. Methods: Twenty patients undergoing single-stage CCSS were managed according to our extubation protocol. Patients were maintained intubated overnight following surgery. They were extubated if a CLT>200mL and both ICU and Neurosurgery teams agreed that it was safe. Patients extubated in the first postoperative day (8/20) comprised the Early group, and the remaining patients (12/20) the Delayed group. Patient and operative data were analyzed as a single group and comparing both groups. Results: The main indication for surgery was cervical deformity. Median number of levels fused was 5 anteriorly (range, 1-6) and 6 (range, 1-13) posteriorly. Patients were kept intubated for an average of 73.6 (range, 26-222) hours and stayed in the ICU for 119.1 (range, 36-360) hours. There were four failed extubations and three patients (15%) required a tracheostomy. Patient profiles between both groups were very similar across most patient variables but differed significantly regarding infraglottic luminal area (p<0.05). Patients with larger preoperative cuff leak values tended to have a shorter intubation period (p=0.053). Conclusion: This study objectively demonstrates the difficulties in airway management following CCSS and provides useful insight for preoperative planning and counseling. Local anatomic factors influence airway outcome more than operative factors. The study format does A c c e p t e d A r t i c l e not allow for testing of interventions but we suggest that patients with favorable anatomy (larger infraglottic luminal area) may benefit from a less strict airway management protocol.

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Intra-individual Variation of the Cuff-Leak Test as a Predictor of Post-Extubation Stridor

Cited by 26 publications

References 19 publications

The Cuff Leak Test: Does It “Leak” Any Information?

The Cuff Leak Test: Does It “Leak” Any Information?

Tracheal extubation of the adult intensive care patient with a predicted difficult airway – a narrative review

Analysis and Temporal Evolution of Extubation Parameters for Patients Undergoing Single-Stage Circumferential Cervical Spine Surgery

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