The cuff leak test in critically ill patients: An international survey of intensivists

Kimberley Lewis^{1

2}, Yousef Almubarak³, Morten Hylander Møller^{4

5}, Roman Jaeschke^{1

2}, Dan Perri^{1

6}, Ying Zhang⁷, Bin Du⁸, Osamu Nishida⁹, George Ntoumenopoulos¹⁰, Manoj Saxena¹¹, Jonathon Truwit¹², Paul J Young^{13

14

15

16}, Fayez Alshamsi¹⁷, Yaseen M Arabi¹⁸, Bram Rochwerg^{1

2}, Tim Karachi¹, Wojciech Szczeklik¹⁹, Muhammed Alshahrani²⁰, Flavia R Machado²¹, Djillali Annane²², Massimo Antonelli²³, Timothy D Girard²⁴, Deborah Cook^{1

2}, Bandar Baw^{6

25}, Rahul Nanchal²⁶, Thomas Piraino²⁷, Gordon Guyatt^{1

2}, Waleed Alhazzani^{1

2}; GUIDE Group

Affiliations

¹ Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
³ College of Medicine, Department of Internal Medicine and Critical Care, Imam Abdulrahman Ben Faisal University, Al Khobar, Kingdom of Saudi Arabia.
⁴ Department of Intensive Care Medicine, Copenhagen University Hospital, Rigshspitalet, Denmark.
⁵ Scandinavian Society of Anesthesiology and Intensive Care Medicine, Rigshspitalet, Denmark.
⁶ Clinical Pharmacology and Toxicology, McMaster University, Hamilton, Canada.
⁷ Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
⁸ Medical ICU, Peking Union Medical College Hospital, Beijing, China.
⁹ Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan.
¹⁰ Physiotherapy Department, St Vincent's Hospital, Sydney, Australia.
¹¹ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
¹² Department of Pulmonary and Critical Care Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
¹³ Intensive Care Unit, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand.
¹⁴ Intensive Care Research Programme, Medical Research Institute of New Zealand, Wellington, New Zealand.
¹⁵ Department of Critical Care, University of Melbourne, Melbourne, Australia.
¹⁶ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
¹⁷ Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Alain, United Arab Emirates.
¹⁸ College of Medicine, Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
¹⁹ Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
²⁰ College of Medicine, Department of Emergency and Critical Care, Imam Abdulrahman Ben Faisal University, Al Khobar, Kingdom of Saudi Arabia.
²¹ Anesthesiology, Pain, and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil.
²² Department of Intensive Care Medicine, University of Versailles SQY, University Paris Saclay, Raymond Poincare Hospital (AP-HP), Garches, France.
²³ Istituto di Anestesia e Risnimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS- Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
²⁵ Division of Emergency Medicine, McMaster University, Hamilton, Canada.
²⁶ Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
²⁷ Division of Critical Care, St. Michael's Hospital, Toronto, Canada.

PMID: 36169641
DOI: 10.1111/aas.13838

The cuff leak test in critically ill patients: An international survey of intensivists

Kimberley Lewis et al. Acta Anaesthesiol Scand. 2021 Sep.

. 2021 Sep;65(8):1087-1094.

doi: 10.1111/aas.13838. Epub 2021 Jun 16.

Authors

Affiliations

¹ Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada.
² Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
³ College of Medicine, Department of Internal Medicine and Critical Care, Imam Abdulrahman Ben Faisal University, Al Khobar, Kingdom of Saudi Arabia.
⁴ Department of Intensive Care Medicine, Copenhagen University Hospital, Rigshspitalet, Denmark.
⁵ Scandinavian Society of Anesthesiology and Intensive Care Medicine, Rigshspitalet, Denmark.
⁶ Clinical Pharmacology and Toxicology, McMaster University, Hamilton, Canada.
⁷ Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
⁸ Medical ICU, Peking Union Medical College Hospital, Beijing, China.
⁹ Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan.
¹⁰ Physiotherapy Department, St Vincent's Hospital, Sydney, Australia.
¹¹ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
¹² Department of Pulmonary and Critical Care Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA.
¹³ Intensive Care Unit, Wellington Hospital, Capital and Coast District Health Board, Wellington, New Zealand.
¹⁴ Intensive Care Research Programme, Medical Research Institute of New Zealand, Wellington, New Zealand.
¹⁵ Department of Critical Care, University of Melbourne, Melbourne, Australia.
¹⁶ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
¹⁷ Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Alain, United Arab Emirates.
¹⁸ College of Medicine, Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
¹⁹ Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
²⁰ College of Medicine, Department of Emergency and Critical Care, Imam Abdulrahman Ben Faisal University, Al Khobar, Kingdom of Saudi Arabia.
²¹ Anesthesiology, Pain, and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil.
²² Department of Intensive Care Medicine, University of Versailles SQY, University Paris Saclay, Raymond Poincare Hospital (AP-HP), Garches, France.
²³ Istituto di Anestesia e Risnimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS- Università Cattolica del Sacro Cuore, Rome, Italy.
²⁴ Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
²⁵ Division of Emergency Medicine, McMaster University, Hamilton, Canada.
²⁶ Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
²⁷ Division of Critical Care, St. Michael's Hospital, Toronto, Canada.

PMID: 36169641
DOI: 10.1111/aas.13838

Abstract

Background: The cuff leak test (CLT) is used to assess laryngeal edema prior to extubation. There is limited evidence for its diagnostic accuracy and conflicting guidelines surrounding its use in critically ill patients who do not have risk factors for laryngeal edema. The primary study aim was to describe intensivists' beliefs, attitudes, and practice regarding the use of the CLT.

Methods: A 13-item survey was developed, pilot-tested, and subjected to clinical sensibility testing. The survey was distributed electronically through MetaClinician®. Descriptive statistics and multivariable regression analysis were performed to examine associations between participant demographics and survey responses.

Results: 1184 practicing intensivists from 17 countries in North and South America, Europe, Oceania, and Asia participated. The majority (59%) of respondents reported rarely or never perform the CLT prior to extubating patients not at high risk of laryngeal edema, which correlated with 54% of respondents reporting they believed a failed CLT did not predict reintubation. Intensivists from the Middle East were 2.4 times more likely to request a CLT compared to those from North America. Intensivists with base training in medicine or emergency medicine were more likely to request a CLT prior to extubation compared to those with base training in anesthesiology.

Conclusion: Use of the CLT prior to extubating patients not at high risk of laryngeal edema in the intensive care unit is highly variable. Practice appears to be influenced by country of practice and base specialty training.

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References

1. Kuriyama A, Jackson JL, Kamei J. Performance of the cuff leak test in adults in predicting post‐extubation airway complications: a systematic review and meta‐analysis. Crit Care. 2020;24(1):640. https://doi.org/10.1186/s13054‐020‐03358‐8
1. Epstein SK, Ciubotaru Rl. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med. 1998;158:489–493.
1. Demling RH, Read T, Lind LJ, Flanagan HL. Incidence and morbidity of extubation failure in surgical intensive care patients. Crit Care Med. 1988;16(6):573–577.
1. Esteban A, Alía I, Gordo F, et al. Extubation outcome after spontaneous breathing trials with t‐tube or pressure support ventilation. Am J Respir Crit Care Med. 1997;156:459–465.
1. Frutos‐Vivar F, Esteban A, Apezteguia C, et al. Outcome of reintubated patients after scheduled extubation. J Crit Care. 2011;26:502–509.

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The cuff leak test in critically ill patients: An international survey of intensivists

Affiliations

The cuff leak test in critically ill patients: An international survey of intensivists

Authors

Affiliations

Abstract

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources