- The cuff leak test is used to predict risk of post-extubation stridor in intubated patients
- Use and interpretation of the test needs to take into account the overall context of the patient’s condition and the management implications
- does not exclude obstruction due to supraglottic structures being splinted apart while the ETT is in situ
- Suction endotracheal and oral secretions and set the ventilator in the assist control mode with the patient receiving volume-cycled ventilation
- With the cuff inflated, record displayed inspiratory and expiratory tidal volumes to see whether these are similar
- Deflate the cuff
- Directly record the expiratory tidal volume over the next six breathing cycles as the expiratory tidal volume will reach a plateau value after a few cycles
- Average the three lowest values
- The difference between the inspiratory tidal volume (measured before the cuff was deflated) and the averaged expiratory tidal volume (after cuff deflation) is the cuff leak volume
- suggested approach is to use 110 mL or 10% of tidal volume as the cut-off
- >110 mL difference in expiratory tidal volumes before and after cuff down has NPV 98% for post-extubation stridor in the original study by Miller and Cole (essentially rules it out)
- different cut-offs and performance characteristics in different studies (see Ochoa et al, 2009)
- tracheal extubation can still be successful in many patients with a positive test (low value)
- a low value for cuff leak can also be caused by encrusted secretions around the tube rather than by a narrowed upper airway
References and Links
- CCC — Post-extubation Stridor
- CCC — Extubation Assessment in ICU
- CCC — Weaning from Mechanical Ventilation
Journal articles and textbooks
- De Backer D. The cuff-leak test: what are we measuring? Crit Care. 2005 Feb;9(1):31-3. Epub 2004 Dec 17. PubMed PMID: 15693980; PubMed Central PMCID: PMC1065116.
- Miller RL, Cole RP. Association between reduced cuff leak volume and postextubation stridor. Chest. 1996 Oct;110(4):1035-40. PubMed PMID: 8874265.
- Ochoa ME, Marín Mdel C, Frutos-Vivar F, Gordo F, Latour-Pérez J, Calvo E, Esteban A. Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med. 2009 Jul;35(7):1171-9. doi: 10.1007/s00134-009-1501-9. Epub 2009 Apr 28. Review. PubMed PMID: 19399474.
- Prinianakis G, Alexopoulou C, Mamidakis E, Kondili E, Georgopoulos D. Determinants of the cuff-leak test: a physiological study. Crit Care. 2005 Feb;9(1):R24-31. Epub 2004 Nov 29. PubMed PMID: 15693963; PubMed Central PMCID: PMC1065107.
- Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, Bergmans DC. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009;13(6):233. Epub 2009 Dec 1. Review. PubMed PMID: 20017891; PubMed Central PMCID: PMC2811912.