PURPOSE: Laryngeal edema occurs in up to 30% of patients on mechanical ventilator and leads to 1 - 5% re-intubation. We conducted a prospective study to evaluate the utility of the cuff leak test in assessing upper airway edema comparing patients with normal voice to those with hoarseness and stridor post extubation.
METHODS: We studied patients requiring mechanical ventilation between May 2009 and January 2010. After consent weaning parameters were obtained and a cuff leak assessment was performed. The cuff leak percent was calculated using mean inspired and expired tidal volumes. The presence of cuff leak defined as leak > 15% based on literature. Patients were assessed for stridor and the voice quality within 60 min post extubation. Extubation failure was defined as re-intubation within 24 hours.
RESULTS: We included a total of 51 patients in the study after excluding patients without consent. There were 31 males and 20 females, median age 56 years (18 - 84), median duration of intubation 3.5 days (0 - 19). We compared those with cuff leak to those without. 84% of patients without cuff leak had hoarseness. Median cuff leak in patients with hoarseness was 24.1%. Four patients had stridor, all had a cuff leak > 15%.One patient was reintubated secondary to developing stridor a few hours after having a normal voice. He had no cuff leak at the time of extubation. Two patients were initially intubated because of angioedema. Both were males. One had hoarseness, cuff leak 37%. The second patient had stridor, cuff leak was 76%.
CONCLUSION: The cuff leak test at the time of extubation can be used to assess for upper airway edema. Patients with hoarseness were more likely to have a cuff leak <15% compared to those with normal voice.Cuff leak does not appear to predict post extubation stridor in this population.
CLINICAL IMPLICATIONS: The presence or absence of cuff leak did not predict extubation failure.The presence of hoarseness may be an indicator of the presence of upper airway edema.
DISCLOSURE: Kavan Ramachandran, No Financial Disclosure Information; No Product/Research Disclosure Information