Document Detail


The cuff leak test to predict failure of tracheal extubation for laryngeal edema.
MedLine Citation:
PMID:  12209275     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Laryngeal edema secondary to endotracheal intubation may require early re-intubation. Prior to extubation the absence of leak around an endotracheal tube may predict laryngeal edema after extubation. We evaluated the usefulness of a quantitative assessment of such a leak to identify the patients who will require early re-intubation for laryngeal edema. METHODS: This prospective study included 76 patients with endotracheal intubation for more than 12 h. The leak, in percent, was defined as the difference between expired tidal volume measured just before extubation, in volume-controlled mode, with the cuff inflated and then deflated. The best cut-off value to predict the need for re-intubation for significant laryngeal edema was determined and the patients were divided into two groups, according to this cut-off value. RESULTS: Eight of the 76 patients (11%) needed re-intubation for laryngeal edema. Patients requiring re-intubation had a smaller leak than the other patients [9 (3-18) vs 35 (13-53)%, p<0.01]. The best cut-off value for gas leak was 15.5%. The high leak group included 51 patients, of whom only two patients (3%) required re-intubation. The low leak group included 25 patients, among whom six patients (24%) required re-intubation ( p<0.01). The sensitivity of this test was 75%, the specificity 72.1%, the positive predictive value 25%, the negative predictive value 96.1% and the percent of correct classification 72.4%. CONCLUSIONS: A gas leak around the endotracheal tube greater than 15.5% can be used as a screening test to limit the risk of re-intubation for laryngeal edema.
Authors:
Yann De Bast; Daniel De Backer; Jean-Jacques Moraine; Muriel Lemaire; Cécile Vandenborght; Jean-Louis Vincent
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Publication Detail:
Type:  Journal Article     Date:  2002-08-10
Journal Detail:
Title:  Intensive care medicine     Volume:  28     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-09-04     Completed Date:  2002-12-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1267-72     Citation Subset:  IM    
Affiliation:
Department of Intensive Care, Erasme University Hospital, Free University of Brussels, 808 route de Lennick, 1070 Brussels, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Aged
Belgium
Humans
Intubation, Intratracheal / adverse effects*
Laryngeal Edema / physiopathology,  therapy*
Middle Aged
Prospective Studies
Respiration, Artificial / adverse effects*
Sensitivity and Specificity
Tidal Volume

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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