Cuff-leak test predicts the severity of postextubation acute laryngeal lesions: a preliminary study

BACKGROUND AND OBJECTIVE: The objectives of the present study were to evaluate the relationships between the results of the cuff-leak test and the presence of laryngeal lesions; to assess whether lesions needing pharmacological treatment and surveillance can be predicted by the cuff-leak test; and to analyse the relationships between these lesions and postextubation stridor. METHODS: The present study is a preliminary, prospective, clinical investigation set in an 11-bed ICU of a university hospital. We studied 50 consecutive adult patients admitted to the ICU and mechanically ventilated for more than 72 h. All patients underwent cuff-leak test before extubation. A laryngoscopic inspection was performed after extubation to evaluate the presence and degrees of laryngeal lesions. Laryngeal lesions were classified according to a 5-degree scale (0-4); patients with clinical manifestations were pharmacologically treated and monitored. RESULTS: A threshold cuff-leak value of 0.07 l (21% of tidal volume) was determined by visual inspection of the receiver-operating characteristic plot. Patients were divided into a positive and a negative cuff-leak test group. Comparing the severity of laryngeal lesions to the cuff-leak test, a relationship between higher degrees of lesions (degrees 3-4) and the positivity of the cuff-leak test (31.3% in the positive cuff-leak test group vs. 3.8% in the negative cuff-leak test group; P = 0.023) was observed. The positive and the negative predictive values were 25 and 96.1%, respectively. Only two cases of postextubation stridor were found, one in each group. There was no correlation between the results of the cuff-leak test and the occurrence of postextubation acute respiratory difficulties. CONCLUSION: Cuff-leak test is a simple, noninvasive tool, which may be useful to exclude, in patients with prolonged intubations, the presence of laryngeal injuries needing medical treatment and close monitoring. This occurs independently of postextubation stridor.