Cuff-leak test predicts the severity of postextubation acute laryngeal lesions: a preliminary study.
OBJECTIVE
The objectives of the present study were to evaluate the relationships between the results of the cuff-leak test and the presence of laryngeal lesions; to assess whether lesions needing pharmacological treatment and surveillance can be predicted by the cuff-leak test; and to analyse the relationships between these lesions and postextubation stridor.


METHODS
The present study is a preliminary, prospective, clinical investigation set in an 11-bed ICU of a university hospital. We studied 50 consecutive adult patients admitted to the ICU and mechanically ventilated for more than 72 h. All patients underwent cuff-leak test before extubation. A laryngoscopic inspection was performed after extubation to evaluate the presence and degrees of laryngeal lesions. Laryngeal lesions were classified according to a 5-degree scale (0-4); patients with clinical manifestations were pharmacologically treated and monitored.


RESULTS
A threshold cuff-leak value of 0.07 l (21% of tidal volume) was determined by visual inspection of the receiver-operating characteristic plot. Patients were divided into a positive and a negative cuff-leak test group. Comparing the severity of laryngeal lesions to the cuff-leak test, a relationship between higher degrees of lesions (degrees 3-4) and the positivity of the cuff-leak test (31.3% in the positive cuff-leak test group vs. 3.8% in the negative cuff-leak test group; P = 0.023) was observed. The positive and the negative predictive values were 25 and 96.1%, respectively. Only two cases of postextubation stridor were found, one in each group. There was no correlation between the results of the cuff-leak test and the occurrence of postextubation acute respiratory difficulties.


CONCLUSIONS
Cuff-leak test is a simple, noninvasive tool, which may be useful to exclude, in patients with prolonged intubations, the presence of laryngeal injuries needing medical treatment and close monitoring. This occurs independently of postextubation stridor.
Antonaglia
Vittorio
V
Department of Perioperative Medicine, Intensive Care and Emergency, Laboratory of Respiratory Biomechanics, Cattinara Hospital, Trieste, Italy. v.antonaglia@gmail.com
Vergolini
Antonella
A
Pascotto
Sara
S
Bonini
Pierluigi
P
Renco
Massimiliano
M
Peratoner
Alberto
A
Buscema
Giovanni
G
De Simoni
Loredana
L
D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007818:Laryngeal Diseases / Q000209:etiology*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects*; D012135:Respiratory Sounds / Q000209:etiology; D012680:Sensitivity and Specificity; D013997:Time Factors