Cuff Leak Test and Airway Obstruction in Mechanically Ventilated Intensive Care Unit Patients: A Pilot Randomized Controlled Clinical Trial

Lewis, Kimberley; Culgin, Sarah; Jaeschke, Roman; Perri, Dan; Marchildon, Corry; Hassall, Kelly; Almubarak, Yousef; Szczeklik, Wojciech; Piraino, Thomas; Thabane, Lehana; Alqahtani, Khaled M.; Alghamdi, Abdulazez; Alshahrani, Mohammed; Alhazzani, Waleed

doi:10.1513/annalsats.202103-390oc

“…Although the transit time ranges from a few minutes to several hours, it may bring about all kinds of side effects due to the limitations of medical conditions, alterations in the environment, uneven transport and escort personnel, different conditions, and poor stability [ 4 ]. The study reported that the incidence of adverse events in transit was 31.3%, even as high as 70% [ 5 ]. Critical patients in hospital transport are prone to adverse reactions such as change in blood pressure, decrease of SpO 2 , arrhythmia, and change of consciousness, among which the decrease of SpO 2 is the most common [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Multifactor Logistic Analysis to Explore the Risk Factors of Safety Risks in the Transport of Critically Ill Patients with ICU and the Improvement of Nursing Strategies

Zhang

¹

,

Qu

²

,

Gong

³

2022

Computational and Mathematical Methods in Medicine

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Objective. Multivariate logistic analysis was employed to explore the risk factors of safety risks in the transport of critically ill patients with ICU and the improvement of nursing strategies. Methods. Two hundred critical transport patients with ICU treated in our hospital from January 2019 to April 2021 were enrolled. According to the occurrence of unsafe events in transit, the patients were assigned to the control group (165 cases without unsafe events, n = 165 ) and the study group (35 cases with safety incidents, n = 35 ). Multivariate logistic analysis was employed to explore the risk factors of safety risks in the transport of critically ill patients with ICU and to enhance nursing strategies. Results. (1) General data of the subjects: among the 200 critically ill patients with ICU who needed in-hospital transport, the age ranged from 18 to 85 years with an average age of 52.48 ± 3.31 , including 89 males and 111 females. There were 35 cases of gastrointestinal bleeding, 16 cases of respiratory failure, 23 cases of heart failure, 43 cases of myocardial infarction, 26 cases of cerebrovascular accident, 14 cases of ectopic pregnancy, 25 cases of severe injury, and 18 cases of mechanical ventilation. There were 35 cases in the study group with accidents and 45 cases in group B without accidents. (2) Among the 200 patients, 35 patients had complications during the transit process in the intermediate people’s court, with an incidence rate of 17.5%. It included blood pressure fluctuation ( n = 6 ), artificial airway obstruction ( n = 6 ), decrease in blood oxygen saturation ( n = 10 ), dyspnea ( n = 5 ), fall pain ( n = 3 ), elevated intracranial pressure ( n = 2 ), and other factors ( n = 3 ). There exhibited no significant difference in blood oxygen saturation at each time point during transport ( P > 0.05 ). There exhibited no significant difference in SpO2 before transport. The comparison of 5 min and 10 min blood oxygen saturation during transit in the study group was lower compared to the control group ( P < 0.05 ). (3) In a univariate analysis of safety risks for critically ill ICU patients, home escorts did not show significant differences in hospital transport for critically ill ICU patients ( P > 0.05 ). There were significant differences in terms of age, patient’s condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline ( P < 0.05 ). The results of multivariate logistic regression analysis indicated that age, patient’s condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline were the risk factors affecting the safe transport of critically ill patients ( P < 0.05 ). Conclusion. Age, patient’s condition, transport escort, auxiliary ventilation, means of transport, uncarried drugs and goods, and carrying pipeline are the independent risk factors that affect the safe transport of emergency or ICU critically ill patients. Therefore, in order to reduce the risk of transshipment, we must enhance the safety awareness of escorts, strengthen the management and training of escorts, promote rules and regulations, and formulate dangerous plans, so as to eliminate the occurrence of unsafe factors.

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“…A negative leak test refers to the absence of an air leak and indicates an elevated risk of upper airway obstruction and re-intubation, in this case, likely due to extensive subcutaneous air [12]. A positive leak test refers to the presence of an air leak and indicates that there are likely no upper airway obstructions that would necessitate reintubation [12]. Upon extubation, the patient was mildly lethargic but was in no respiratory distress, and his mental status exams improved throughout the day.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient remained intubated, sedated, and mechanically ventilated with 100% oxygen until postoperative day 3 when he passed an endotracheal cuff leak test and was extubated. An endotracheal cuff leak test refers to partially deflating the endotracheal tube cuff and auscultating with a stethoscope to identify an audible air leak around the cuff [12]. A negative leak test refers to the absence of an air leak and indicates an elevated risk of upper airway obstruction and re-intubation, in this case, likely due to extensive subcutaneous air [12].…”

Section: Discussionmentioning

confidence: 99%

“…An endotracheal cuff leak test refers to partially deflating the endotracheal tube cuff and auscultating with a stethoscope to identify an audible air leak around the cuff [12]. A negative leak test refers to the absence of an air leak and indicates an elevated risk of upper airway obstruction and re-intubation, in this case, likely due to extensive subcutaneous air [12]. A positive leak test refers to the presence of an air leak and indicates that there are likely no upper airway obstructions that would necessitate reintubation [12].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Development of Extensive Subcutaneous Emphysema Following Robotic Total Abdominal Colectomy Due to Lynch Syndrome: A Case Report

Garcia,

Irvine,

Tomasello

et al. 2024

Cureus

0

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Subcutaneous emphysema, the presence of air in the subcutaneous layer of the skin, is a possible result of surgical, infectious, or spontaneous etiologies. Although usually self-limiting, the development of subcutaneous emphysema in the perioperative period has been associated with delayed extubation and the development of complications such as pneumomediastinum, pneumoperitoneum, and pneumothorax and can worsen clinical outcomes in these patients. Here, we report the case of a 57-year-old male patient who presented to the operating room (OR) for a robotic total colectomy due to Lynch syndrome. The procedure was complicated by the development of diffuse, severe subcutaneous emphysema, which was recognized by palpable crepitus and obscuration of anatomical landmarks during an attempted transversus abdominis plane (TAP) block for pain control prior to patient extubation. The decision was made to leave the patient intubated and managed postoperatively in the ICU, where radiographic and computerized tomography (CT) scans confirmed the severity of subcutaneous emphysema. Hemodynamic and respiratory status were managed in the ICU and on postoperative day 3 the patient passed an endotracheal cuff leak test and was extubated. The patient was transferred to a surgical step-down on postoperative day 7 and following the resolution of ileus and acute kidney injury (AKI), he was discharged from the hospital on postoperative day 17.

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“…CLT determines the space available between the larynx and the trachea and can be quantitatively and qualitatively assessed. [6] A meta-analysis of nine studies published in 2009 estimated that the sensitivity and specificity of the cuff leakage test were 56% and 92%, respectively. [7] Another meta-analysis of 14 observational studies showed that although the delay in extubation increased by 9%, the cuff leakage test reduced the incidence of post extubation wheezing (4 vs 7%) and the rate of reintubation (2.4 vs 4.2%).…”

Section: Discussionmentioning

confidence: 99%

The difficult removal of tracheal tube after general anesthesia: A case report

Li¹,

Yan²,

Li³

et al. 2022

Medicine

0

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Background: Laryngeal injury is common after endotracheal intubation, presenting with varying degrees of edema, ulceration, granulation, and limited vocal cord movement, usually resulting in lumen narrowing. In these cases, laryngeal edema is a common complication after intubation, usually caused by direct pressure and inflammatory reaction caused by endotracheal intubation on the contact surface.Case presentation: A 71-year-old female was scheduled to undergo open reduction and internal fixation of femoral neck. On admission, she was diagnosed with femoral neck fracture. Tracheal intubation induced by general anesthesia was successful, but the tracheal catheter was difficult to remove after the operation. After 2 days of detumescence in ICU, the extubation was successful under the condition of complete recovery of spontaneous breathing.Conclusions: Patients undergoing general anesthesia may have laryngeal or glottic edema due to operation time, operation and other reasons, resulting in difficulty in extubation after general anesthesia. The extubation action shall be gentle. In case of obvious resistance, it shall not be forcibly extubated to prevent serious dyspnea after extubation.

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Cuff Leak Test and Airway Obstruction in Mechanically Ventilated Intensive Care Unit Patients: A Pilot Randomized Controlled Clinical Trial

Cited by 6 publications

References 16 publications

Multifactor Logistic Analysis to Explore the Risk Factors of Safety Risks in the Transport of Critically Ill Patients with ICU and the Improvement of Nursing Strategies

Multifactor Logistic Analysis to Explore the Risk Factors of Safety Risks in the Transport of Critically Ill Patients with ICU and the Improvement of Nursing Strategies

The Development of Extensive Subcutaneous Emphysema Following Robotic Total Abdominal Colectomy Due to Lynch Syndrome: A Case Report

The difficult removal of tracheal tube after general anesthesia: A case report

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