As many of us have undoubtedly experienced, we are now extubating patients in the ED due to prolonged lengths of stay
Critical to extubation is determining whether laryngeal edema may be present
Laryngeal edema, resulting in airway obstruction, is one of the most common causes of respiratory distress following extubation
Although shown to have moderate accuracy, many use the 'cuff leak test' to determine the iikelihood of laryngeal edema
In most studies, performance of the cuff leak test is as follows:
take the average of 6 serial measurements of expired tidal volume with the ETT cuff inflated
take the average of 6 serial measurements of expired tidal volume with the ETT cuff deflated
a difference of < 110 ml between averages strongly suggests the presence of laryngeal edema
Take Home Point: patients with a cuff leak test < 110 ml are likely to have laryngeal edema and are at high risk of airway obstruction post-extubation. It is best not to extubate these patients in the ED.
References
Ochoa ME, et al. Cuff leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis. Intensive Care Med 2009;35(7):1171-9.
