The endotracheal tube cuff-leak test as a predictor for postextubation stridor

Eric J. Kriner, Shirin Shafazand, Gene L. Colice

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

BACKGROUND: The endotracheal tube (ETT) cuff-leak test (CLT) has been proposed as a relatively simple, noninvasive method for detecting the presence of laryngeal edema prior to tracheal extubation. OBJECTIVE: To determine the value of the CLT for predicting postextubation stridor (PES) among medical and surgical patients, and to assess the impact of certain variables on the incidence of PES. METHODS: We conducted a prospective, observational study in the intensive care unit at Washington Hospital Center, a 907-bed acute care hospital in Washington DC, with patients who were intubated for > 24 h. As part of respiratory therapy quality assurance, patients intubated for > 24 h are evaluated daily for extubation readiness, and CLT is conducted prior to extubation. The CLT results and the postextubation outcomes were prospectively recorded for 6 months. RESULTS: Of the 462 patients studied, 20 (4.3%) developed PES that required treatment; 7 of those 20 (1.5%) required reintubation. With patients who failed the CLT, defined by an absolute leak volume ≤ 110 mL, the positive predictive value for PES was 0.12, the negative predictive value was 0.97, the sensitivity was 0.50, and the specificity was 0.84. Using different definitions for CLT failure did not improve the accuracy of CLT for predicting PES. Patients who had PES were more likely to be female (6.5% vs 2.4%, p = 0.04), to have a longer duration of translaryngeal intubation (6.5 ± 4 d vs 4.5 ± 4 d, p = 0.02), and to have a larger ratio of ETT size to laryngeal size (49.5 ± 6% vs 45.5 ± 6%, p = 0.01). CONCLUSIONS: Failing the CLT was not an accurate predictor of PES and should not be used as an indication for either delaying extubation or initiating other specific therapy. Female patients, those whose ratio of ETT size to laryngeal diameter was > 45%, and patients intubated for > 6 d were more likely to develop PES.

Original languageEnglish
Pages (from-to)1632-1638
Number of pages7
JournalRespiratory Care
Volume50
Issue number12
StatePublished - Dec 1 2005
Externally publishedYes

Fingerprint

Respiratory Sounds
Laryngeal Edema
Airway Extubation
Respiratory Therapy
Intubation
Observational Studies
Intensive Care Units
Prospective Studies
Incidence
Therapeutics

Keywords

  • Airway obstruction
  • Endotracheal tube cuff
  • Extubation failure
  • Laryngeal edema
  • Stridor
  • Tracheal intubation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

The endotracheal tube cuff-leak test as a predictor for postextubation stridor. / Kriner, Eric J.; Shafazand, Shirin; Colice, Gene L.

In: Respiratory Care, Vol. 50, No. 12, 01.12.2005, p. 1632-1638.

Research output: Contribution to journalArticle

Kriner, Eric J. ; Shafazand, Shirin ; Colice, Gene L. / The endotracheal tube cuff-leak test as a predictor for postextubation stridor. In: Respiratory Care. 2005 ; Vol. 50, No. 12. pp. 1632-1638.
@article{65204aae69ad4399a7fbb1a6aac739f1,
title = "The endotracheal tube cuff-leak test as a predictor for postextubation stridor",
abstract = "BACKGROUND: The endotracheal tube (ETT) cuff-leak test (CLT) has been proposed as a relatively simple, noninvasive method for detecting the presence of laryngeal edema prior to tracheal extubation. OBJECTIVE: To determine the value of the CLT for predicting postextubation stridor (PES) among medical and surgical patients, and to assess the impact of certain variables on the incidence of PES. METHODS: We conducted a prospective, observational study in the intensive care unit at Washington Hospital Center, a 907-bed acute care hospital in Washington DC, with patients who were intubated for > 24 h. As part of respiratory therapy quality assurance, patients intubated for > 24 h are evaluated daily for extubation readiness, and CLT is conducted prior to extubation. The CLT results and the postextubation outcomes were prospectively recorded for 6 months. RESULTS: Of the 462 patients studied, 20 (4.3{\%}) developed PES that required treatment; 7 of those 20 (1.5{\%}) required reintubation. With patients who failed the CLT, defined by an absolute leak volume ≤ 110 mL, the positive predictive value for PES was 0.12, the negative predictive value was 0.97, the sensitivity was 0.50, and the specificity was 0.84. Using different definitions for CLT failure did not improve the accuracy of CLT for predicting PES. Patients who had PES were more likely to be female (6.5{\%} vs 2.4{\%}, p = 0.04), to have a longer duration of translaryngeal intubation (6.5 ± 4 d vs 4.5 ± 4 d, p = 0.02), and to have a larger ratio of ETT size to laryngeal size (49.5 ± 6{\%} vs 45.5 ± 6{\%}, p = 0.01). CONCLUSIONS: Failing the CLT was not an accurate predictor of PES and should not be used as an indication for either delaying extubation or initiating other specific therapy. Female patients, those whose ratio of ETT size to laryngeal diameter was > 45{\%}, and patients intubated for > 6 d were more likely to develop PES.",
keywords = "Airway obstruction, Endotracheal tube cuff, Extubation failure, Laryngeal edema, Stridor, Tracheal intubation",
author = "Kriner, {Eric J.} and Shirin Shafazand and Colice, {Gene L.}",
year = "2005",
month = "12",
day = "1",
language = "English",
volume = "50",
pages = "1632--1638",
journal = "Respiratory Care",
issn = "0098-9142",
publisher = "Daedalus Enterprises Inc.",
number = "12",

}

TY - JOUR

T1 - The endotracheal tube cuff-leak test as a predictor for postextubation stridor

AU - Kriner, Eric J.

AU - Shafazand, Shirin

AU - Colice, Gene L.

PY - 2005/12/1

Y1 - 2005/12/1

N2 - BACKGROUND: The endotracheal tube (ETT) cuff-leak test (CLT) has been proposed as a relatively simple, noninvasive method for detecting the presence of laryngeal edema prior to tracheal extubation. OBJECTIVE: To determine the value of the CLT for predicting postextubation stridor (PES) among medical and surgical patients, and to assess the impact of certain variables on the incidence of PES. METHODS: We conducted a prospective, observational study in the intensive care unit at Washington Hospital Center, a 907-bed acute care hospital in Washington DC, with patients who were intubated for > 24 h. As part of respiratory therapy quality assurance, patients intubated for > 24 h are evaluated daily for extubation readiness, and CLT is conducted prior to extubation. The CLT results and the postextubation outcomes were prospectively recorded for 6 months. RESULTS: Of the 462 patients studied, 20 (4.3%) developed PES that required treatment; 7 of those 20 (1.5%) required reintubation. With patients who failed the CLT, defined by an absolute leak volume ≤ 110 mL, the positive predictive value for PES was 0.12, the negative predictive value was 0.97, the sensitivity was 0.50, and the specificity was 0.84. Using different definitions for CLT failure did not improve the accuracy of CLT for predicting PES. Patients who had PES were more likely to be female (6.5% vs 2.4%, p = 0.04), to have a longer duration of translaryngeal intubation (6.5 ± 4 d vs 4.5 ± 4 d, p = 0.02), and to have a larger ratio of ETT size to laryngeal size (49.5 ± 6% vs 45.5 ± 6%, p = 0.01). CONCLUSIONS: Failing the CLT was not an accurate predictor of PES and should not be used as an indication for either delaying extubation or initiating other specific therapy. Female patients, those whose ratio of ETT size to laryngeal diameter was > 45%, and patients intubated for > 6 d were more likely to develop PES.

AB - BACKGROUND: The endotracheal tube (ETT) cuff-leak test (CLT) has been proposed as a relatively simple, noninvasive method for detecting the presence of laryngeal edema prior to tracheal extubation. OBJECTIVE: To determine the value of the CLT for predicting postextubation stridor (PES) among medical and surgical patients, and to assess the impact of certain variables on the incidence of PES. METHODS: We conducted a prospective, observational study in the intensive care unit at Washington Hospital Center, a 907-bed acute care hospital in Washington DC, with patients who were intubated for > 24 h. As part of respiratory therapy quality assurance, patients intubated for > 24 h are evaluated daily for extubation readiness, and CLT is conducted prior to extubation. The CLT results and the postextubation outcomes were prospectively recorded for 6 months. RESULTS: Of the 462 patients studied, 20 (4.3%) developed PES that required treatment; 7 of those 20 (1.5%) required reintubation. With patients who failed the CLT, defined by an absolute leak volume ≤ 110 mL, the positive predictive value for PES was 0.12, the negative predictive value was 0.97, the sensitivity was 0.50, and the specificity was 0.84. Using different definitions for CLT failure did not improve the accuracy of CLT for predicting PES. Patients who had PES were more likely to be female (6.5% vs 2.4%, p = 0.04), to have a longer duration of translaryngeal intubation (6.5 ± 4 d vs 4.5 ± 4 d, p = 0.02), and to have a larger ratio of ETT size to laryngeal size (49.5 ± 6% vs 45.5 ± 6%, p = 0.01). CONCLUSIONS: Failing the CLT was not an accurate predictor of PES and should not be used as an indication for either delaying extubation or initiating other specific therapy. Female patients, those whose ratio of ETT size to laryngeal diameter was > 45%, and patients intubated for > 6 d were more likely to develop PES.

KW - Airway obstruction

KW - Endotracheal tube cuff

KW - Extubation failure

KW - Laryngeal edema

KW - Stridor

KW - Tracheal intubation

UR - http://www.scopus.com/inward/record.url?scp=33644874217&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33644874217&partnerID=8YFLogxK

M3 - Article

C2 - 16318644

AN - SCOPUS:33644874217

VL - 50

SP - 1632

EP - 1638

JO - Respiratory Care

JF - Respiratory Care

SN - 0098-9142

IS - 12

ER -