title: Cuff leak test and laryngeal survey for predicting post-extubation stridor.
abstract: OBJECTIVE
  Evidence for the predictive value of the cuff leak test (CLT) for post-extubation stridor (PES) is conflicting. We evaluated the association and accuracy of CLT alone or combined with other laryngeal parameters with PES.
  
  
  METHODS
  Fifty-one mechanically ventilated adult patients in a medical-surgical intensive care unit were tested prior to extubation using; CLT, laryngeal ultrasound and indirect laryngoscopy. Biometric, laryngeal and endotracheal tube (ETT) parameters were recorded.
  
  
  RESULTS
  PES incidence was 4%. CLT demonstrated 'no leak' in 20% of patients. Laryngeal oedema was present in 10% of the patients on indirect laryngoscopy, and 71% of the patients had a Grades 1-3 indirect laryngoscopic view. Mean air column width on laryngeal ultrasound was 0.66 ± 0.15 cm (cuff deflated), mean ratio of ETT to laryngeal diameter was 0.48 ± 0.07, and the calculated CLT and laryngeal survey composite was 0.86 ± 1.25 (range 0-5). CLT and the CLT and Laryngeal survey composite measure were not associated with or predict PES. Age, sex, peri-extubation steroid use, intubation duration and body mass index were not associated with PES.
  
  
  CONCLUSIONS
  Even including ultrasonographic and indirect laryngoscopic examination of the airway, no single aspect of the CLT or combination with laryngeal parameters accurately predicts PES.
authors: Department of Internal Medicine, Alameda County Medical Center, Oakland, CA 94602, USA.
authors: Anit B
authors: AB
authors: Patel
authors: Department of Internal Medicine, Alameda County Medical Center, Charles Drew University of Medicine and Science, Lynwood, CA 90262, USA.
authors: Chizobam
authors: C
authors: Ani
authors: Department of Internal Medicine, Division of Critical Care, Alameda County Medical Center, Oakland, CA 94602, San Francisco, CA 94143, USA ; Department of Internal Medicine, University of California, San Francisco, CA 94143, USA.
authors: Colin
authors: C
authors: Feeney
keywords: Post-extubation stridor; laryngeal edema; risk predictors