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Year : 2015  |  Volume : 59  |  Issue : 2  |  Page : 96-102

Cuff leak test and laryngeal survey for predicting post-extubation stridor

1 Department of Internal Medicine, Alameda County Medical Center, Oakland, CA 94602, USA
2 Department of Internal Medicine, Alameda County Medical Center, Charles Drew University of Medicine and Science, Lynwood, CA 90262, USA
3 Department of Internal Medicine, Division of Critical Care, Alameda County Medical Center, Oakland, CA 94602; Department of Internal Medicine, University of California, San Francisco, CA 94143, USA

Correspondence Address:
Dr. Colin Feeney
Department of Medicine, Division of Critical Care, Alameda County Medical Center, 1411 East 31st Street, Oakland, CA 94602
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5049.151371

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Background and Aims: Evidence for the predictive value of the cuff leak test (CLT) for post-extubation stridor (PES) is conflicting. We evaluated the association and accuracy of CLT alone or combined with other laryngeal parameters with PES. Methods: Fifty-one mechanically ventilated adult patients in a medical-surgical intensive care unit were tested prior to extubation using; CLT, laryngeal ultrasound and indirect laryngoscopy. Biometric, laryngeal and endotracheal tube (ETT) parameters were recorded. Results: PES incidence was 4%. CLT demonstrated 'no leak' in 20% of patients. Laryngeal oedema was present in 10% of the patients on indirect laryngoscopy, and 71% of the patients had a Grades 1-3 indirect laryngoscopic view. Mean air column width on laryngeal ultrasound was 0.66 ± 0.15 cm (cuff deflated), mean ratio of ETT to laryngeal diameter was 0.48 ± 0.07, and the calculated CLT and laryngeal survey composite was 0.86 ± 1.25 (range 0-5). CLT and the CLT and Laryngeal survey composite measure were not associated with or predict PES. Age, sex, peri-extubation steroid use, intubation duration and body mass index were not associated with PES. Conclusion: Even including ultrasonographic and indirect laryngoscopic examination of the airway, no single aspect of the CLT or combination with laryngeal parameters accurately predicts PES.

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