Cuff-leak test for predicting postextubation airway complications: a systematic review

Area of Science:

• Critical Care Medicine
• Pulmonology
• Anesthesiology

Background:

• Postextubation airway complications, including laryngeal edema and reintubation, are frequent after tracheal intubation.
• The cuff-leak test is a proposed clinical tool to identify high-risk patients, but its diagnostic accuracy is debated.

Purpose of the Study:

• To systematically evaluate the diagnostic accuracy of the cuff-leak test for predicting postextubation airway complications.
• To assess the impact of cuff-leak test screening on patient-important outcomes.

Main Methods:

• A comprehensive literature search was conducted across multiple electronic databases.
• Included studies assessed the accuracy of the cuff-leak test and its effect on outcomes.
• Data extraction and quality assessment (using QUADAS tool) were performed independently by two reviewers.

Main Results:

• Sixteen diagnostic accuracy studies (3172 participants) and six clinical trials (2500 patients) were identified.
• The cuff-leak test demonstrated moderate to high diagnostic odds ratios for predicting laryngeal edema and reintubation.
• Accuracy varied based on methodology, intubation duration, and patient population; screening showed a significant reduction in laryngeal edema but not reintubation.

Conclusions:

• The cuff-leak test appears to be an accurate method for identifying adult patients at high risk of postextubation airway complications.
• High-quality randomized controlled trials are recommended to validate this diagnostic strategy and its clinical utility.