Cuff Leak Case Study

The cuff-leak test for as a predictor for extubation:

Fisher and Raper(11) (1992) tested the leak among 62 patients with upper airway obstruction. They were able to extubate all patients with a cuff leak. Two patients extubated without cuff leak required reintubation and in five patients who repeatedly failed the test, tracheostomy was performed. Subsequently, they extubated 10 patients who were stable on spontaneous ventilation and did not have cuff leak; three later required tracheostomy and seven were uneventfully extubated. So they concluded that while the presence of cuff leak demonstrates that extubation is likely to be successful, a failed cuff-leak test does not preclude uneventful extubation and if used as a criterion for extubation may lead to

They concluded that in a population of medical intensive care unit spontaneously breathing patients, just before extubation, the presence of leaking around the endotracheal tube rules out postextubation stridor. On the other hand Engoren(12) in his study that was conducted in a cardiovascular ICU after cardiac surgery over 531 extubations in 524 cardiac surgery patients disagree with all previous results. Twenty patients among them had positive leak test (a leak ≤ 110 mL). None of the 20 patients with a positive leak test developed problems. Three patients had postextubation stridor. Their leaks were 433, 312, and 350 mL. So he concluded that The cuff-leak test is inaccurate and cannot be recommended for routine use in this population.

However, in the Engoren study, the length of intubation was less than 24 h (median 12 h), which limits comparison of the results of this study with those previously