Sage Journals: Discover world-class research

Abstract

BACKGROUND: Postextubation stridor as a result of laryngeal edema has been reported in up to 5% of patients who have received mechanical ventilation for longer than 24 hours. The cuff-leak test has been proposed as a method of determining whether patients can be extubated without developing upper airway obstruction. This test, however, has not been prospectively studied. METHODS: 100 consecutive patients who had been intubated for longer than 24 hours were studied prior to extubation. The cuff-leak test was performed by two different methods. The endotracheal cuff was totally deflated, the lumen of the endotracheal tube was then occluded, and the presence (small or large) or absence of a peritubular leak during spontaneous ventilation was determined. The test was then repeated with positive pressure ventilation using the patients’ pre-weaning tidal volume. The results were not available to the intensivist, and the patients were extubated regardless of the results of the leak tests. RESULTS: The mean (SD) length of intubation was 3.8 (3.2) days. Six patients had no leak with both tests, 22 patients had a small leak with both tests, and 60 patients had a large air leak with both tests. Twelve patients had a small leak with one test and a large leak with the other. Two patients developed postextubation stridor. Both were successfully treated with aerosolized racemic epinephrine. These two patients had no leak with either test, making the likelihood of developing stridor significantly higher in the group of patients that had no peritubular leak prior to extubation (p = 0.003). The cuff-leak tests had a negative predictive value of 100% but a positive predictive value of only 33%. CONCLUSION: The presence of a cuff leak indicates that postextubation stridor is unlikely. Although the absence of a cuff leak does not guarantee extubation difficulty, such patients should be observed closely during the immediate postextubation period [Respir Care 1996;41(6):509-511].

Get full access to this article

View all access options for this article.

References

McGovern

, Fitz-Hugh

, Edgemon

. The hazards of endotracheal intubation. Ann Otol Rhinol Laryngol 1971;80:556–564.

Bishop

, Weymuller

Jr , Fink

. Laryngeal effects of prolonged intubation. Anesth Anal 1984;63(3):335–342.

Rashkin

, Davis

Acute complications of endotracheal intubation: relationship to reintubation, route, urgency, and duration. Chest 1986;89(2):165–167.

Harrison

, Tonkin

. Prolonged (therapeutic) endotracheal intubation. Br J Anaesth 1968;40(4):241–248.

Bishop

. Mechanisms of laryngotracheal injury following prolonged tracheal intubation. Chest 1989;96(1):185–186.

Potgieter

, Hammond

. "Cuff" test for safe extubation following laryngeal edema (letter). Crit Care Med 1988;16(8):818.

Levy

, Griego

A comparative study of oral endotracheal tube securing methods. Chest 1993;104(5):1537–1540.

Deming

, Oech

. Steroid and antihistaminic therapy for postintubation subglottic edema. Anesthesiology 1961;22:933–936.

Knaus

, Draper

, Wagner

, Zimmerman

. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818–829.

10.

Singer

, Wilson

. Laryngotracheobronchitis: 2 years’ experience with racemic epinephrine. Can Med Assoc J 1976;115(2):132–134.

11.

Nutman

, Brooks

, Deakins

, Baldesare

, Witte

, Reed

. Racemic versus l-epinephrine aerosol in the treatment of postextubation laryngeal edema: results from a prospective randomized, double blind-study. Crit Care Med 1994;22(10):1591–1594.

12.

Brochard

, Rauss

, Benito

, Conti

, Mancebo

, Rekik

et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Resp Crit Care Med 1994;150(4):896–903.

13.

Demling

, Read

, Lind

, Flanagan

. Incidence and morbidity of extubation failure in surgical intensive care patients. Crit Care Med 1988;16(6):573–577.

14.

Darmon

, Rauss

, Dreyfuss

, Bleicher

, Elkharrat

, Schlem-mar

et al. Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. A placebo-controlled, double-blind, multicenter study. Anesthesiology 1992;77(2):245–251.

15.

Way

, Sooy

. Histologic changes produced by endotracheal intubation. Ann Otol 1965;74:799–813.

16.

Conrardy

, Goodman

, Lainge

, Singer

. Alteration of endotracheal tube position. Flexion and extension of the neck. Crit Care Med 1976;4(1):7–12.

17.

Fisher

, Raper

. The "cuff-leak" test for extubation. Anaesthesia 1992;47(1):10–12.

The Cuff-Leak Test as A predictor of Postextubation Stridor: A Prospective Study

Abstract

Get full access to this article

References