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Utilization of a Risk Stratification Tool and Volume-Based Cuff Leak Test to Assess Postextubation Stridor.

Richard H Kallet1, Aya Matsushima2, Susan Yoo3

  • 1Department of Anesthesia and Perioperative Care, University of California, San Francisco at San Francisco General Hospital, San Francisco, California. richkallet@gmail.com.

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Summary

The cuff leak test (CLT) effectively identifies patients at high risk for postextubation stridor (PES). A leak volume below 110 mL significantly increases PES likelihood, aiding critical care safety protocols.

Keywords:
airway extubationairway managementairway obstructioncuff leak testlaryngeal edemapostextubation stridor

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Area of Science:

  • Critical Care Medicine
  • Respiratory Therapy
  • Patient Safety

Background:

  • Postextubation stridor (PES) poses a significant life-threatening risk.
  • Systematic screening for PES risk factors and standardized testing are crucial for patient safety.
  • This study evaluated a volume-based cuff leak test (CLT) for PES risk assessment in ICU patients.

Purpose of the Study:

  • To assess the effectiveness of a volume-based cuff leak test (CLT) in identifying patients at risk for postextubation stridor (PES).
  • To establish a standardized method for evaluating PES risk in predominantly surgical-trauma and neurotrauma intensive care unit (ICU) populations.

Main Methods:

  • Retrospective analysis of quality assurance data from May 2010 to December 2017.
  • Trained respiratory therapists performed standardized PES risk assessment and volume-based CLT.
  • A cutoff leak volume of < 110 mL was used to define a positive test for PES.

Main Results:

  • Approximately 85% of 681 CLTs yielded true-negative results.
  • The positive predictive value for PES was 0.42, and the negative predictive value was 0.94.
  • The likelihood ratio for PES was 7.0, with an overall correct classification rate of 89%.

Conclusions:

  • A cuff leak volume ≥ 110 mL was associated with a low risk (∼6%) of PES.
  • A cuff leak volume < 110 mL indicated a 7-fold increased risk of developing PES.
  • The CLT is a valuable tool for stratifying PES risk in intubated patients.