The Prognostic Value of Endotracheal Tube-Air Leak Following Tracheal Surgery in Children

Seid, Allan B.; Godin, Michael S.; Pransky, Seth M.; Kearns, David R.; Peterson, Bradley M.

doi:10.1001/archotol.1991.01870200074011

Cited by 21 publications

(9 citation statements)

References 8 publications

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“…For intubated patients with known upper airway pathology, including intubation after upper airway surgical reconstruction, burns, or laryngotracheobronchitis, the ALT may be an accurate predictor of extubation outcome (8,9). Small, single-center retrospective studies measuring the ALT in pharmacologically aralyzed patients found that an ALT < 20 cm H 2 O prior to extubation was associated with a 100% extubation success rate while an ALT > 30 H 2 O was 100% predictive of post-extubation stridor and/or reintubation (8-10).…”

Section: Discussionmentioning

confidence: 99%

“…For a given patient, the ALT measurement will vary if midline head positioning is not maintained, if the patient is not pharmacologically paralyzed, and if testing is performed by more than one observer (9, 17, 36). Finholt et al provided the original description of ALT measurements performed in the setting of complete pharmacologic paralysis with the patient's head supine and midline (17).…”

Section: Discussionmentioning

confidence: 99%

“…16 If the pressure required to produce an air leak is “high” (i.e., ALT ≥ 30 cm H 2 O), the clinician may infer that the ETT is “tight” within the upper airway secondary to acquired upper airway edema and/or the presence of a larger than appropriate ETT size (8-20). In a small case series evaluating the predictive value of the ALT measured prior to extubation in patients who are mechanically ventilated and pharmacologically paralyzed following laryngotracheal reconstruction or cricoid split surgery, an ALT < 20 cm H 2 O was 100% sensitive in those patients with a successful extubation, whereas an ALT ≥ 30 cm H 2 O was 100% predictive of post-extubation stridor or the need for reintubation (9). …”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…In a recent survey of pediatric critical care fellowship directors, 76% of the physicians in this survey routinely use this test prior to extubation [63]. There are some data to suggest that in pediatric patients there is an increased risk for post-extubation stridor or extubation failure when there is absence of a leak around the endotracheal tube (ETT) or leak at a pressure greater than 30 cm H 2 O [64,65]. Mhanna et al [66] demonstrated in a retrospective review that a leak around the ETT at a pressure greater than 20 cm H 2 O had a sensitivity of 83.3% in predicting post-extubation stridor in patients age 7 years or older.…”

Section: Weaning Mechanical Ventilatory Support and Extubationmentioning

confidence: 99%

Insights in pediatric ventilation: timing of intubation, ventilatory strategies, and weaning

Turner

Arnold

2007

Current Opinion in Critical Care

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Mechanical ventilation with pressure limitation and low tidal volumes has become customary in pediatric intensive care units, and this lung protective approach will continue into the foreseeable future. Further investigation is warranted regarding use of high frequency oscillatory ventilation, airway pressure release ventilation, and surfactant to assist pediatric intensivists in application of these therapies.

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“…Once subglottic edema has settled, signified by a lowpressure leak around the indwelling tube, the child is extubated. 30 Cotton et al 31 reported in 1995 the Cincinnati experience of SS-LTR. One hundred sixteen children underwent SS-LTR with endotracheal tube stenting.…”

Section: Arch Otolaryngol Head Neckmentioning

confidence: 99%

Single-Stage Laryngotracheal Reconstruction

McQueen

Shapiro²,

Leighton³

et al. 1999

Arch Otolaryngol Head Neck Surg

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The Prognostic Value of Endotracheal Tube-Air Leak Following Tracheal Surgery in Children

Cited by 21 publications

References 8 publications

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

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

Insights in pediatric ventilation: timing of intubation, ventilatory strategies, and weaning

Single-Stage Laryngotracheal Reconstruction

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