The air-leak test is not a good predictor of postextubation adverse events in children undergoing cardiac surgery.
OBJECTIVE
The air-leak test is recommended as a method of assessing the appropriate size of an uncuffed endotracheal tube (ETT) in children. The authors' primary objective was to determine whether the air-leak test would predict adverse events and reintubations after the removal of the ETT in children who have undergone cardiac surgery.


METHODS
Prospective, observational, clinical study.


METHODS
University tertiary care hospital.


METHODS
Ninety-four children <10 years of age undergoing elective cardiac surgery requiring cardiopulmonary bypass surgery.


METHODS
The attending anesthesiologist assessed air-leak pressure after intubation in the operating room (OR). In addition, the air-leak test was performed in 42 patients before extubation in the pediatric intensive care unit (PICU). The incidence of adverse events and the number of failed extubations were recorded after removal of the ETT.


RESULTS
Eleven of the 94 patients were excluded from the study. Four (4.3%) of the patients died in the PICU before extubation, and 7 patients were excluded for other reasons. The median age of the 83 children was 0.9 years (range 0.01-9.6 years). The total incidences of postextubation adverse events and failed extubations were 30.1% and 8.4%, respectively. An audible air leak < or =25 cmH(2)O airway pressure during the OR phase or before removal of the ETT during the PICU recovery phase had no significant predictive value for the incidence of adverse events (p = 0.63) or reintubations (p = 1.0). The patients undergoing simple and complete operations compared with more complex and incomplete operations had significantly fewer postextubation adverse events (p = 0.03). Neonates did not have a higher risk for postextubation adverse events (p = 0.64) or reintubations (p = 0.26) than older children.


CONCLUSIONS
The air-leak test did not predict an increased risk for postextubation adverse events and reintubations in children undergoing elective congenital heart surgery.
Suominen
Pertti K
PK
Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland. psuominen@hmc.psu.edu
Tuominen
Netta A
NA
Salminen
Jukka T
JT
Korpela
Reijo E
RE
Klockars
Jaakko G M
JG
Taivainen
Tomi R
TR
Meretoja
Olli A
OA
D000399:Air Pressure; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D019544:Equipment Failure Analysis; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome