Introduction: Post-extubation stridor (PES) is a well-known complication of intubation resulting from laryngeal edema. The cuff leak test (CLT) is frequently used to predict PES, although demonstrates limited diagnostic performance and may expose patients to unnecessary avoidance of extubation.1
Objectives: This study was conducted to identify the incidence of an initial failed CLT in a general ICU population, as well as to identify factors associated with a failed cuff leak test.
Methods: A single-centered case-control study of mechanically ventilated, critically ill patients was conducted from September 2012 to August 2017. Controls were matched for age and sex.
Results: Cuff leak tests were reported for 1430 of all 3805 intubated patients (37.6%) over a five year period. We identified 92 patients with a failed CLT (6.4%). Most patients with a failed CLT were not clearly high risk for PES based on historical features (58/92, 63%). However, patients with a failed CLT were more likely to have high risk features for PES compared to patients without a cuff leak (OR 4.3, 95% CI 2.0-9.2), have longer duration of intubation (7.9 days vs 5.9 days, p=0.03), and longer duration from CLT to extubation (2.6 vs 1.1 days, p=0.01). Failed CLT was not associated with intubation indication, endotracheal tube size, fluid balance, increased rates of PES or reintubation, but was associated with progression to tracheostomy (OR 8.7, 1.1-70.8).
Conclusions: Our results suggest that cuff leak testing is commonly performed in the general ICU population. The presence of a failed CLT is associated with delayed extubation and prolonged duration of intubation. These results inform the upcoming COMIC study, a randomized control trial investigating whether use of the CLT impacts relevant clinical outcomes.
Introduction: Post-extubation stridor (PES) is a well-known complication of intubation resulting from laryngeal edema. The cuff leak test (CLT) is frequently used to predict PES, although demonstrates limited diagnostic performance and may expose patients to unnecessary avoidance of extubation.1
Objectives: This study was conducted to identify the incidence of an initial failed CLT in a general ICU population, as well as to identify factors associated with a failed cuff leak test.
Methods: A single-centered case-control study of mechanically ventilated, critically ill patients was conducted from September 2012 to August 2017. Controls were matched for age and sex.
Results: Cuff leak tests were reported for 1430 of all 3805 intubated patients (37.6%) over a five year period. We identified 92 patients with a failed CLT (6.4%). Most patients with a failed CLT were not clearly high risk for PES based on historical features (58/92, 63%). However, patients with a failed CLT were more likely to have high risk features for PES compared to patients without a cuff leak (OR 4.3, 95% CI 2.0-9.2), have longer duration of intubation (7.9 days vs 5.9 days, p=0.03), and longer duration from CLT to extubation (2.6 vs 1.1 days, p=0.01). Failed CLT was not associated with intubation indication, endotracheal tube size, fluid balance, increased rates of PES or reintubation, but was associated with progression to tracheostomy (OR 8.7, 1.1-70.8).
Conclusions: Our results suggest that cuff leak testing is commonly performed in the general ICU population. The presence of a failed CLT is associated with delayed extubation and prolonged duration of intubation. These results inform the upcoming COMIC study, a randomized control trial investigating whether use of the CLT impacts relevant clinical outcomes.
Introduction: Post-extubation stridor (PES) is a well-known complication of intubation resulting from laryngeal edema. The cuff leak test (CLT) is frequently used to predict PES, although demonstrates limited diagnostic performance and may expose patients to unnecessary avoidance of extubation.1
Objectives: This study was conducted to identify the incidence of an initial failed CLT in a general ICU population, as well as to identify factors associated with a failed cuff leak test.
Methods: A single-centered case-control study of mechanically ventilated, critically ill patients was conducted from September 2012 to August 2017. Controls were matched for age and sex.
Results: Cuff leak tests were reported for 1430 of all 3805 intubated patients (37.6%) over a five year period. We identified 92 patients with a failed CLT (6.4%). Most patients with a failed CLT were not clearly high risk for PES based on historical features (58/92, 63%). However, patients with a failed CLT were more likely to have high risk features for PES compared to patients without a cuff leak (OR 4.3, 95% CI 2.0-9.2), have longer duration of intubation (7.9 days vs 5.9 days, p=0.03), and longer duration from CLT to extubation (2.6 vs 1.1 days, p=0.01). Failed CLT was not associated with intubation indication, endotracheal tube size, fluid balance, increased rates of PES or reintubation, but was associated with progression to tracheostomy (OR 8.7, 1.1-70.8).
Conclusions: Our results suggest that cuff leak testing is commonly performed in the general ICU population. The presence of a failed CLT is associated with delayed extubation and prolonged duration of intubation. These results inform the upcoming COMIC study, a randomized control trial investigating whether use of the CLT impacts relevant clinical outcomes.
Introduction: Post-extubation stridor (PES) is a well-known complication of intubation resulting from laryngeal edema. The cuff leak test (CLT) is frequently used to predict PES, although demonstrates limited diagnostic performance and may expose patients to unnecessary avoidance of extubation.1
Objectives: This study was conducted to identify the incidence of an initial failed CLT in a general ICU population, as well as to identify factors associated with a failed cuff leak test.
Methods: A single-centered case-control study of mechanically ventilated, critically ill patients was conducted from September 2012 to August 2017. Controls were matched for age and sex.
Results: Cuff leak tests were reported for 1430 of all 3805 intubated patients (37.6%) over a five year period. We identified 92 patients with a failed CLT (6.4%). Most patients with a failed CLT were not clearly high risk for PES based on historical features (58/92, 63%). However, patients with a failed CLT were more likely to have high risk features for PES compared to patients without a cuff leak (OR 4.3, 95% CI 2.0-9.2), have longer duration of intubation (7.9 days vs 5.9 days, p=0.03), and longer duration from CLT to extubation (2.6 vs 1.1 days, p=0.01). Failed CLT was not associated with intubation indication, endotracheal tube size, fluid balance, increased rates of PES or reintubation, but was associated with progression to tracheostomy (OR 8.7, 1.1-70.8).
Conclusions: Our results suggest that cuff leak testing is commonly performed in the general ICU population. The presence of a failed CLT is associated with delayed extubation and prolonged duration of intubation. These results inform the upcoming COMIC study, a randomized control trial investigating whether use of the CLT impacts relevant clinical outcomes.
