Poster Presentations: Tuesday, November 2, 2010 |

Cuff Leak Test for the Diagnosis of Upper Airway Edema FREE TO VIEW

Raed H. Alalawi, MD; Saba Radhi, MD; Diana M. Guerra, MD; Rishi Raj, MD; Kenneth M. Nugent, MD
Author and Funding Information

Maimonides Medical Center, Brooklyn, NY

Chest. 2010;138(4_MeetingAbstracts):386A. doi:10.1378/chest.10519
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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

12:45 PM - 2:00 PM




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