The Science Journal of the American Association for Respiratory Care
Introduction: The purpose of this study was to determine the predictive value of an endotracheal tube cuff leak on the development of stridor and the need for reintubation.
Methods: Consecutive trauma patients who required intubation at a Level 1 trauma center from 7/97-7/98 were prospectively studied. Pediatric patients and those who did not meet the standard weaning protocol criteria established by our Division were excluded. Injury severity score (ISS), endotracheal tube size, reason for intubation, and days intubated before initial extubation attempt were recorded. At the time of extubation, the difference in actual tidal volume (TV) between pre- and post-endotracheal tube cuff deflation was calculated. This number was then divided by the pre-cuff deflation TV and recorded as the % cuff leak. Patients were followed after extubation for the development of stridor or the need for reintubation. Statistical analysis was performed using Chi-square.
Results: Of the 114 patients analyzed, the most common reason for intubation was closed head injury (48%). 14 patients (12.2%) developed stridor (mean cuff leak = 11.7%), 5 (4.4%) of whom required reintubation (mean cuff leak = 11/0%). The mean cuff leak was 58.3% for the remaining 100 patients (p<0.05). Patients who developed stridor or were reintubated had been intubated for a significantly greater length of time than those not developing stridor or requiring reintubation (6.6 vs 3 days). There were no differences in ISS, endotracheal tube size, or reason for intubation between these groups.
Conclusions: We conclude that the degree of cuff leak (< 11.7%) is useful in identifying patients at risk for developing stridor and/or requiring reintubation. It also appears that the length of intubation prior to the initial extubation attempt correlates with the amount of cuff leak.