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

• Published in: Intensive care medicine 2002-09, Vol.28 (9), p.1267-1272
• Main Authors: DE BAST, Yann, DE BACKER, Daniel, MORAINE, Jean-Jacques, LEMAIRE, Muriel, VANDENBORGHT, Cécile, VINCENT, Jean-Louis
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Belgium; Biological and medical sciences; Emergency and intensive respiratory care; Humans; Intensive care medicine; Intubation, Intratracheal - adverse effects; Laryngeal Edema - physiopathology; Laryngeal Edema - therapy; Medical sciences; Middle Aged; Prospective Studies; Respiration, Artificial - adverse effects; Sensitivity and Specificity; Tidal Volume
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-002-1422-3

Laryngeal edema secondary to endotracheal intubation may require early re-intubation. Prior to extubation the absence of leak around an endotracheal tube may predict laryngeal edema after extubation. We evaluated the usefulness of a quantitative assessment of such a leak to identify the patients who will require early re-intubation for laryngeal edema. This prospective study included 76 patients with endotracheal intubation for more than 12 h. The leak, in percent, was defined as the difference between expired tidal volume measured just before extubation, in volume-controlled mode, with the cuff inflated and then deflated. The best cut-off value to predict the need for re-intubation for significant laryngeal edema was determined and the patients were divided into two groups, according to this cut-off value. Eight of the 76 patients (11%) needed re-intubation for laryngeal edema. Patients requiring re-intubation had a smaller leak than the other patients [9 (3-18) vs 35 (13-53)%, p