The cuff-leak test is a simple tool to verify severe laryngeal edema in patients undergoing long-term mechanical ventilation

2007 ◽  
Vol 2007 ◽  
pp. 41-42
Author(s):  
R.P. Dellinger
Keyword(s):  
Mechanical Ventilation ◽  
Laryngeal Edema ◽  
Leak Test ◽  
Simple Tool ◽  
Cuff Leak

scholarly journals Comparison between Cuff Leak Test and Ultra Sound Assessment of Laryngeal Edema in Predicting Successful Extubation in Mechanically Ventilated Patients

2020 ◽  
pp. 43-51
Author(s):  
Manar Mohammed Ismail ◽  
Sohair Mostafa Soliman ◽  
Hoda Alsaid Ahmed Ezz ◽  
Amr Arafa Elbadry
Keyword(s):  
Endotracheal Intubation ◽  
Ultra Sound ◽  
Laryngeal Edema ◽  
Leak Test ◽  
Vocal Cords ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Cuff Leak ◽  
Ventilated Patients ◽  
Successful Extubation

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.

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

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.

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

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029394 ◽  
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.

The cuff leak test to predict failure of tracheal extubation for laryngeal edema

2002 ◽  
Vol 28 (9) ◽  
pp. 1267-1272 ◽  
Author(s):  
Yann De Bast ◽  
Daniel De Backer ◽  
Jean-Jacques Moraine ◽  
Muriel Lemaire ◽  
Cécile Vandenborght ◽  
...  
Keyword(s):  
Tracheal Extubation ◽  
Laryngeal Edema ◽  
Leak Test ◽  
Cuff Leak

scholarly journals An Extubation Protocol for Angioedema

OTO Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. 2473974X1769123
Author(s):  
Elizabeth Floyd ◽  
Nira A. Goldstein ◽  
Rauno Joks ◽  
Miguel Mascaro ◽  
Christine Liaw ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Direct Laryngoscopy ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Laryngeal Edema ◽  
Fiberoptic Intubation ◽  
Endotracheal Tube Cuff ◽  
Leak Test ◽  
Converting Enzyme Inhibitors ◽  
Tube Cuff ◽  
Cuff Leak

Angioedema—nonpitting edema of the mucous membranes and skin—most commonly occurs as a complication from the use of angiotensin-converting enzyme inhibitors. At our institution, the otolaryngology department has incorporated the use of the endotracheal tube cuff-leak test and bedside direct laryngoscopy to aid in timing for extubation of angioedema patients. Prospective data collection of patients presenting to the emergency department with angioedema was performed. Of 76 patients with angioedema, 9 required fiberoptic intubation. Intubation was performed at a median of 73 hours (range, 44-118). An endotracheal tube cuff-leak test was performed in 7 patients prior to extubation, and bedside direct laryngoscopy was also performed in 3 of these 7 patients to document resolution of laryngeal edema. The use of the endotracheal tube cuff-leak test and bedside direct laryngoscopy is an easy and inexpensive method to help determine eligibility for extubation in patients intubated for angioedema.

PREDICTING LARYNGEAL EDEMA AND STRIDOR UTILIZING CUFF LEAK TEST VS LARYNGEAL AIR COLUMN WIDTH DIFFERENCE: SYSTEMATIC REVIEW AND META-ANALYSIS

CHEST Journal ◽  
2018 ◽  
Vol 154 (4) ◽  
pp. 368A
Author(s):  
TAMER SAID AHMED ◽  
ZUBAIR KHAN ◽  
KHALED SROUR ◽  
ALI ELTATAWY ◽  
MUJAHED ALKHATHLAN ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Laryngeal Edema ◽  
Leak Test ◽  
Width Difference ◽  
Cuff Leak ◽  
Air Column

scholarly journals A Case of Laryngeal Edema Induced after Extubation in Spite of Negative Cuff-Leak Test

2021 ◽  
Vol 41 (3) ◽  
pp. 232-234
Author(s):  
Akira INOUE ◽  
Kunio KANAO ◽  
Kiyotsugu TAKUMA
Keyword(s):  
Laryngeal Edema ◽  
Leak Test ◽  
Cuff Leak

The Cuff Leak Test is Not Predictive of Successful Extubation

2008 ◽  
Vol 74 (12) ◽  
pp. 1182-1185 ◽  
Author(s):  
Susanna H. Shin ◽  
Kirk Heath ◽  
Scott Reed ◽  
Jay Collins ◽  
L.J. Weireter ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Chart Review ◽  
Laryngeal Edema ◽  
Trauma Patients ◽  
Respiratory Therapists ◽  
Trauma Service ◽  
Trauma Population ◽  
Before And After ◽  
Cuff Leak ◽  
Successful Extubation

In intubated patients the presence of a cuff leak (CL) is used as a predictor of successful extubation. CL is proposed to indicate laryngeal edema and predict which patients may develop complications such as postextubation stridor and eventual reintubation. Our objective was to evaluate the reliability of CL in our population of critically ill trauma patients. A retrospective chart review was performed of patients admitted to the trauma service who required mechanical ventilation. All patients undergo the CL test by a single respiratory therapist team before attempted extubation. Data collected included body mass index (BMI), endotracheal tube (ETT) size, length of time of mechanical ventilation, tidal volumes (Vt), and the size of the patient's trachea based on CT scan. The test is performed by the respiratory therapists and involves measuring expired Vt before and after the ETT cuff has been deflated and listening for an audible leak. A positive test result is defined as a CL greater than 10 per cent of Vt or, when volumes are not available, as audible air expired. From October 2005 to May 2006, 150 mechanically ventilated patients were identified and 49 charts were available for review. Forty-one patients had a cuff leak (+CL), whereas eight did not (-CL). The two cohorts were similar in age (+CL = 36.5 years, –CL = 38.1 years, P = 0.82), male gender (+CL = 70%, -CL = 50%, P = 0.25) ETT size (+CL = 7.4, –CL = 7.4, P = 0.57), and BMI (+CL = 28 kg/m2, -CL = 27 kg/m2, P = 0.71). The average tracheal diameter (+CL = 17.4 mm, -CL = 17.5 mm, P = 0.90) as well as the ratio of ETT and tracheal diameter was similar for the two cohorts (+CL = 0.65, –CL = 0.64, P = 0.73). Four patients (10%) in the +CL cohort failed extubation, whereas none of the –CL cohort failed (0%) (P = 0.40). The CL test does not reliably identify those patients who will require reintubation in our trauma population. In addition, the ratio of ETT and tracheal diameter is not predictive of successful extubation.

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