Association Between Cuff Leak Test Results and Reintubation Risk: A Retrospective Analysis

Postextubation airway obstruction represents a significant complication in critical care, potentially necessitating reintubation and prolonging intensive care unit (ICU) stay. The cuff leak test (CLT) is commonly used to predict postextubation stridor and reintubation risk, but its clinical utility remains controversial. This study evaluated the relationship between CLT results and reintubation risk in a large cohort of critically ill patients.

This single-center, retrospective, descriptive study analyzed 742 adult patients admitted to the medical and surgical ICUs who underwent mechanical ventilation for ≥24 h between January 2020 and December 2024. The primary outcome was reintubation within 48 h of planned extubation. Quantitative cuff leak volume measurements were performed preextubation, with leak volume expressed as absolute values and percentage of tidal volume. Multivariable logistic regression was used to identify independent predictors of reintubation, including CLT results and patient characteristics.

Of the 742 patients studied, 68 (9.2%) required reintubation within 48 h. Patients with a cuff leak volume <110 mL or <15% of tidal volume had significantly higher reintubation rates (18.7% vs. 7.1%, P  < 0.001). After adjusting for confounding variables, a positive CLT (defined as cuff leak volume <110 mL) remained independently associated with reintubation (adjusted odds ratio, 2.86; 95% confidence interval [CI], 1.65-4.97; P  < 0.001). Other significant independent predictors included prolonged intubation (>7 days), female sex, body mass index >30 kg/m 2 , and traumatic or difficult intubation. Combining CLT results with these clinical risk factors improved prediction accuracy (area under the curve, 0.82; 95% CI, 0.76-0.87).

A positive CLT is independently associated with increased reintubation risk in critically ill patients. The predictive accuracy is enhanced when CLT results are combined with clinical risk factors. These findings suggest that CLT should be incorporated into extubation decision-making, particularly for patients with additional risk factors for postextubation airway complications.