Ultrasound-guided laryngeal air column width difference and the cuff leak volume in predicting the effectiveness of steroid therapy on postextubation stridor in adult. Are they useful?

Elbaradey, Ghada Fouad; Elshmaa, Nagat S.; Elsharawy, Fatma

doi:10.1016/j.jcrc.2016.07.007

Cited by 14 publications

(22 citation statements)

References 21 publications

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“…Five studies used a qualitative cuff leak test (auscultation of airflow) [ 23 , 28 , 31 , 39 , 45 ], and 21 used a quantitative measurement of the cuff leak [ 12 , 13 , 21 , 22 , 29 , 30 , 32 – 37 , 40 – 44 , 46 , 47 , 49 , 50 ] (Table 2 ). One study reported the results from both qualitative and quantitative cuff leak tests examined in a single cohort [ 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…The most frequent cutoff values for quantitative cuff leak tests ranged from 50 to 283 mL (median, 110 mL) in volume and from 10 to 57% in proportion. Twenty studies used assist control ventilation [ 12 , 13 , 21 , 22 , 29 , 30 , 32 – 38 , 41 – 44 , 46 , 47 , 49 ] , and four used spontaneous breathing including pressure support ventilation [ 23 , 31 , 40 , 45 ]. Another study examined either of these two ventilation modes [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

“…Laryngeal air column width difference is the difference between width of airway at the level of the vocal cord with cuff inflated and deflated. Its reported sensitivity and specificity varied across studies, ranging from 50 to 91% and 54 to 72%, respectively [ 44 , 46 , 49 ]. Laryngeal air column width ratio is the ratio of air column width before extubation over that after intubation.…”

Section: Discussionmentioning

confidence: 99%

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Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis

2020

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Background Clinical practice guidelines recommend performing a cuff leak test in mechanically ventilated adults who meet extubation criteria to screen those at high risk for post-extubation stridor. Previous systematic reviews demonstrated excellent specificity of the cuff leak test but disagreed with respect to sensitivity. We conducted a systematic review and meta-analysis to assess the diagnostic accuracy of the cuff leak test for predicting post-extubation airway complications in intubated adult patients in critical care settings. Methods We searched Medline, EMBASE, Scopus, ISI Web of Science, the Cochrane Library for eligible studies from inception to March 16, 2020, without language restrictions. We included studies that examined the diagnostic accuracy of cuff leak test if post-extubation airway obstruction after extubation or reintubation was explicitly reported as the reference standard. Two authors in duplicate and independently assessed the risk of bias using the Quality Assessment for Diagnostic Accuracy Studies-2 tool. We pooled sensitivities and specificities using generalized linear mixed model approach to bivariate random-effects meta-analysis. Our primary outcomes were post-extubation airway obstruction and reintubation. Results We included 28 studies involving 4493 extubations. Three studies were at low risk for all QUADAS-2 risk of bias domains. The pooled sensitivity and specificity of cuff leak test for post-extubation airway obstruction were 0.62 (95% CI 0.49–0.73; I2 = 81.6%) and 0.87 (95% CI 0.82–0.90; I2 = 97.8%), respectively. The pooled sensitivity and specificity of the cuff leak test for reintubation were 0.66 (95% CI 0.46–0.81; I2 = 48.9%) and 0.88 (95% CI 0.83–0.92; I2 = 87.4%), respectively. Subgroup analyses suggested that the type of cuff leak test and length of intubation might be the cause of statistical heterogeneity of sensitivity and specificity, respectively, for post-extubation airway obstruction. Conclusions The cuff leak test has excellent specificity but moderate sensitivity for post-extubation airway obstruction. The high specificity suggests that clinicians should consider intervening in patients with a positive test, but the low sensitivity suggests that patients still need to be closely monitored post-extubation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis

2020

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“…CLT was performed using the volume assist-control mode in this study. This is the main mode of ventilation that was used in past CLT studies [ 2 , 5 , 12 – 14 , 19 ]. Antonaglia et al performed CLT with CPAP; the cuff leak volume was smaller than that in other studies [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, circuit leakage causes patient-ventilator asynchrony [ 15 – 18 ]; therefore, CLT can cause patient-ventilator asynchrony. Several studies that referred to ventilator settings during CLT used volume assist-control [ 5 , 12 – 14 , 19 ]. Volume assist-control is more likely to cause asynchrony than other ventilator modes, such as pressure assist-control and pressure support [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

A novel technique for assessment of post-extubation airway obstruction can successfully replace the conventional cuff leak test: a pilot study

et al. 2022

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Background Post-extubation airway obstruction is an important complication of tracheal intubation. The cuff leak test is traditionally used to estimate the risk of this complication. However, the cuff leak test parameters are not constant and may depend on the respiratory system and ventilator settings. Furthermore, deflating the cuff also be a risk factor for patient-ventilator asynchrony and ventilator-associated pneumonia. Instead of using the cuff leak test, we measured the pressure of the leak to the upper airway through the gap between the tube and glottis with a constant low flow from the lumen above the cuff without deflating the cuff and called it "pressure above the cuff." The purpose of this study was to investigate whether pressure above the cuff can be used as an alternative to the cuff leak volume. Methods This prospective observational study was conducted at Kumamoto University Hospital after obtaining approval from the institutional review board. The pressure above the cuff was measured using an endotracheal tube with an evacuation lumen above the cuff and an automated cuff pressure modulation device. We pumped 0.16 L per minute of air and measured the steady-state pressure using an automated cuff pressure modulation device. Then, the cuff leak test was performed, and the cuff leak volume was recorded. The cuff leak volume was defined as the difference between the expiratory tidal volume with the cuff inflated and deflated. The relationship between the pressure above the cuff and cuff leak volume was evaluated. The patient-ventilator asynchrony during each measurement was also examined. Results The pressure above the cuff was measured, and the cuff leak volume was assessed 27 times. The pressure above the cuff was significantly correlated with the cuff leak volume (r = -0.76, p < 0.001). Patient-ventilator asynchrony was detected in 37% of measurements during the cuff leak test, but not during the pressure above the cuff test. Conclusions This study suggests that pressure above the cuff measurement may be a less complicated alternative to the conventional cuff leak test for evaluation of the risk of post-extubation airway obstruction. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN000039987; March 30, 2020). https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000044604

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Can intubate, but cannot extubate: A practical narrative review on extubation

Onrubia,

Roca de Togores

2023

Trends in Anaesthesia and Critical Care

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Ultrasound-guided laryngeal air column width difference and the cuff leak volume in predicting the effectiveness of steroid therapy on postextubation stridor in adult. Are they useful?

Cited by 14 publications

References 21 publications

Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis

Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis

A novel technique for assessment of post-extubation airway obstruction can successfully replace the conventional cuff leak test: a pilot study

Can intubate, but cannot extubate: A practical narrative review on extubation

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