Cuff-leak test combined with interventional bronchoscopy benefits early extubation for patients who received tarp surgery

Objects: Endotracheal intubation commonly leads to local complications, including mechanical lesions, such as friction and compressions between the tube and the anatomic structures of the larynx leading to laryngeal edemamanifested as ‘‘stridor’’ after extubation. There is no standard method to predict patients at risk of post-extubation stridor. This study was conducted to compare between cuff leak test and ultra sound in predicting successful extubation in mechanically ventilated patients. Patients and Methods: We included a total of 83 mechanically ventilated patients with endotracheal intubation > 24 hours. They were divided according to the outcome after extubation into 72 patients who didn’t develop laryngeal edema and 11 patients who developed laryngeal edema. The patients were extubated when they fulfilled the criteria of extubation and become negative to cuff leak test. All patients underwent both cuff leak test (CLT) and ultra-sound to assess air column width difference (ACWD) after intubation and before extubation. Results: All patients were matched as regard demographic data. There was a significant increase in the duration of mechanical ventilation in the LE group. No significant difference was detected between the two groups regarding CLT and ACWD after intubation. However, cases with laryngeal edema had significantly lower CLT and ACWD before extubation. Using a cut off value of 1.52 mm, ACWD had sensitivity and specificity of 90.9 and 91.7% respectively to predict laryngeal edema after extubation. Conclusions: Laryngeal Ultrasonography could be a useful, reliable, non-invasive method in the evaluation of vocal cords, laryngeal morphology and airflow passing through the vocal cords or subglottic area in intubated patients in comparison with cuff leak test.

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Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study

Scientific Reports ◽

10.1038/s41598-021-99501-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Aiko Tanaka ◽

Akinori Uchiyama ◽

Yu Horiguchi ◽

Ryota Higeno ◽

Ryota Sakaguchi ◽

...

Keyword(s):

Mechanical Ventilation ◽

Observational Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Spontaneous Breathing Trial ◽

Leak Test ◽

Endotracheal Suctioning ◽

Cuff Leak ◽

The Impact

AbstractThe cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5–14] vs. 12 [8–30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01–8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.

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The cuff leak test prior to extubation: A practice based on limited evidence

Saudi Critical Care Journal ◽

10.4103/sccj.sccj_27_17 ◽

2017 ◽

Vol 1 (6) ◽

pp. 22

Author(s):

Waleed Alhazzani ◽

Kim Lewis

Keyword(s):

Limited Evidence ◽

Leak Test ◽

Cuff Leak

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Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients (COMIC): a pilot randomised controlled trial protocol

BMJ Open ◽

10.1136/bmjopen-2019-029394 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029394 ◽

Cited By ~ 1

Author(s):

Kimberley Lewis ◽

Sarah Culgin ◽

Roman Jaeschke ◽

Dan Perri ◽

Corry Marchildon ◽

...

Keyword(s):

Mechanical Ventilation ◽

Controlled Trial ◽

Invasive Mechanical Ventilation ◽

Laryngeal Oedema ◽

Leak Test ◽

Icu Patients ◽

Pilot Randomised Controlled Trial ◽

Mechanically Ventilated ◽

Cuff Leak ◽

Randomised Controlled

IntroductionEndotracheal intubation and invasive mechanical ventilation are lifesaving interventions that are commonly performed in the intensive care unit (ICU). Laryngeal oedema is a known complication of intubation that may cause airway obstruction in a patient on extubation. To date, the only test available to predict this complication is the cuff leak test (CLT); however, its diagnostic accuracy and utility remains uncertain. Herein, we report the protocol for the CuffLeak and AirwayObstruction in MechanicallyVentilated ICU Patients (COMIC) pilottrial.Methods and analysisThis will be a multicentred, pragmatic, pilot randomised controlled trial (RCT). We will enrol 100 mechanically ventilated patients in the ICU who are deemed ready for extubation. We will exclude patients at a high risk of laryngeal oedema. All enrolled patients will have a CLT done before extubation. In the intervention arm, the results of the CLT will be communicated to the bedside physician, and decision to extubate will be left to the treating team. In the control arm, respiratory therapist will not communicate the results of the CLT to the treating physician, and the patient will be extubated regardless of the CLT result. Randomisation will be done in a 1:1 allocation ratio, stratified by size of the endotracheal tube and duration of invasive mechanical ventilation.Although we will examine all clinical outcomes relevant for the future COMIC RCT, the primary outcomes of the COMIC pilottrial will be feasibility outcomes including: consent rate, recruitment rate and protocol adherence. Clinical outcomes include postextubation stridor, reintubation, emergency surgical airway, ICU mortality, in hospital mortality, duration of mechanical ventilation and ICU length of stay in days.Ethics and disseminationThe Hamilton Integrated Research Ethics Board, Imam Abdulrahman Bin Faisal University Institutional Review Board and Bioethical Commission of the Jagiellonian University approved this study. The trial results will be disseminated via publication in peer-reviewed journals.Trial registration numberNCT03372707.

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