PURPOSE: We sought to evaluate whether an endotracheal tube cuff leak volume (CLV) of 110mL versus an audible cuff leak prior to extubation was predictive of stridor or successful extubation. We also sought to characterize our extubation failure rate and reasons for reintubation among critical care units at our institution.
METHODS: From January 2005 to November 2005, endotracheally intubated patients in our medical, surgical, and neurosurgical ICUs had a cuff leak test performed prior to extubation. All patients were switched to volume assist control at a tidal volume (TV) 10mL/kg for the test, and the endotracheal tube cuff was deflated. Machine delivered and exhaled TV were recorded by a respiratory therapist for 5 breaths. The difference of the averaged 5 exhaled TV from inspired TV is the CLV. Respiratory therapists were asked to check for an audible cuff leak by auscultation over the trachea. Patients were then extubated and we recorded the incidence of and reason for reintubation 24 hours post-extubation.
RESULTS: 80 extubations were analyzed. Of those 80, 7 (9%) patients had to be reintubated. Of the 7 reintubated, 1 (14%) was for stridor, 2 (28%) for secretions, 1 (14%) for altered mentation, 1 (14%) for hypoxemic respiratory failure, 1 (14%) for hypercarbia, and 1 (14%) for atelectasis. There were 3 cases (4%) of stridor overall, and the CLV in those patients were all >340mL. None of the reintubated patients had a CLV <220mL. 3 patients had no audible cuff leaks, yet were successfully extubated.
CONCLUSION: Absolute CLV and audible cuff leak are not predictive of stidor or successful extubation at our institution. More information is needed on using percentage based CLV, in which the percentage of CLV/TV is used as a predictive measure, as opposed to the absolute volume used in this study.
CLINICAL IMPLICATIONS: Absolute CLV and audible cuff leak are not sensitive predictors of post extubation stridor and should not be used in general medical/surgical ICU patients.
DISCLOSURE: Dominic Valentino III, None.