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The Cuff Leak Test
- 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.