Pre-Extubation Cuffed Tube Leak Test and Subsequent Post-Extubation Laryngeal Edema: Prospective, Single-Center Evaluation of PICU Patients*

Kanno, Kazuyoshi; Fujiwara, Naoki; Moromizato, Takuhiro; Fujii, Shuichi; Ami, Yuki; Tokushige, Akihiro; Ueda, Shinichiro

doi:10.1097/pcc.0000000000003282

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…Inclusion criteria 2 , 14 , 17 : (1) The research subjects were patients admitted to ICU; (2) The intervention measures were divided into cuffed tracheal intubation and non‐cuffed tracheal intubation; (3) The included studies were randomized controlled trials, prospective or retrospective study.…”

Section: Methodsmentioning

confidence: 99%

“…However，complications associated with endotracheal intubation present a significant concern. 1 , 2 A pressure ulcer, skin breakdown, or infection can prolong hospitalization, increase health care costs, and cause pain to patients. 3 , 4 , 5 One factor that has been studied in relation to these complications is the use of endotracheal tubes with or without integrated cuff sleeves.…”

Section: Introductionmentioning

confidence: 99%

“…In the intensive care unit (ICU), endotracheal intubation is a common treatment to help patients breathe. However，complications associated with endotracheal intubation present a significant concern 1,2 . A pressure ulcer, skin breakdown, or infection can prolong hospitalization, increase health care costs, and cause pain to patients 3–5 .…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13] Given the conflicting evidence on this topic, a comprehensive analysis and synthesis of existing data is necessary to provide a clearer understanding of the potential impact of endotracheal tubes with cuff sleeves on complications in ICU patients. 2,[14][15][16] This study aims to assess the impact of endotracheal tubes with and without cuff sleeves on overall complication rate in ICU patients undergoing intubation.…”

Section: Introductionmentioning

confidence: 99%

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Meta‐analysis of the influence of tracheal intubation with cuff and without cuff on the incidence of total wound complications in ICU intubation patients

Jiang,

Wang,

et al. 2024

International Wound Journal

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At present, it is still controversial whether patients in intensive care unit (ICU) use tracheal intubation with or without cuff. This paper evaluates the effect of tracheal intubation with and without cuff on overall complication rate of patients with intubation in ICU. The database of PubMed, Embase, Conchrane Library and Web of Science was searched by computer, and the clinical research on intubation with and without cuff in ICU was collected. The time range was from the database establishment to November 2023. Literature was independently screened, information was extracted, and quality was assessed by two researchers. Finally, there were nine studies included, with 11 068 patients (7391 in cuff group and 3677 in non‐cuff group). The results showed that the overall complication rate of cuff group was significantly lower than that of non‐cuff group, and that of cuff group (RR = 0.53, p < 0.01). In addition, compared with the non‐cuff group, the cuff group had a lower number of tracheal intubation changes [RR = 0.05, p < 0.01] and a lower incidence of aspiration pneumonia (RR = 0.45, p = 0.01). Compared with the non‐cuff group, the cuff group had a higher incidence of oral mucosal ulcers and pharyngitis (RR = 1.99, p = 0.04), while the cuff group had a lower incidence of laryngeal edema (RR = 0.39, p < 0.01). In ICU intubation patients, the use of cuffs reduces overall complication rate in comparison to patients without cuffs. Therefore, patients with intubation in ICU can recommend tracheal intubation with cuff.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Meta‐analysis of the influence of tracheal intubation with cuff and without cuff on the incidence of total wound complications in ICU intubation patients

Jiang,

Wang,

et al. 2024

International Wound Journal

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Anticipating Pediatric Post-Extubation Risk: Calling All (North) Stars*

Rappold,

Nishisaki

2023

Pediatric Critical Care Medicine

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Pre-Extubation Ultrasound Measurement of In Situ Cuffed Endotracheal Tube Laryngeal Air Column Width Difference: Single-Center Pilot Study of Relationship With Post-Extubation Stridor in Subjects Younger Than 5 Years Old

Burton,

Loberger,

Baker

et al. 2023

Pediatric Critical Care Medicine

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Objectives: Post-extubation stridor (PES) is difficult to predict before extubation. We therefore evaluated the potential diagnostic performance of pre-extubation laryngeal air column width difference (LACWD) measurement, as assessed by intensivist-performed point-of-care laryngeal ultrasound, in relation to clinically important PES. Design: Prospective observational cohort study. Setting: Single quaternary care PICU (July 19, 2021, to October 31, 2022). Patients: Included subjects were younger than 5 years old, intubated with a cuffed endotracheal tube, requiring invasive mechanical ventilation for greater than 24 hours, and nearing extubation. Subjects at high risk for supraglottic airway obstruction were excluded. Interventions: Laryngeal ultrasound with measurement of laryngeal air column width with the endotracheal tube cuff inflated and deflated. Clinically important PES was defined as a high-pitched inspiratory respiratory noise suspected to be from a subglottic focus necessitating received medical intervention or reintubation. Measurements and Main Results: Among 53 enrolled subjects, 18 of 53 (34%) experienced PES and three of 53 (6%) were reintubated because of severe subglottic upper airway obstruction. Median LACWD was significantly lower in the stridor group compared with the nonstridor group (∆ 0.41 mm; 95% CI, 0.37–0.48; p < 0.001). The area under the receiver operating characteristic curve for LACWD as a diagnosis of PES was 0.94 (95% CI, 0.89–1.00; p < 0.001). The LACWD cutoff for PES was less than or equal to 0.47 mm, which yielded a diagnostic sensitivity of 91.4% and specificity of 88.9%. In this population, the pre-to-post-test change in probability of PES for LACWD less than or equal to 0.47 mm is 0.34 to 0.81. Conclusions: Pre-extubation LACWD is a novel, noninvasive assessment that can be performed and interpreted by the intensivist at the bedside. There is, however, diagnostic uncertainty in the use of this measurement for identifying those at-risk of PES and larger validation studies are needed.

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Pre-Extubation Cuffed Tube Leak Test and Subsequent Post-Extubation Laryngeal Edema: Prospective, Single-Center Evaluation of PICU Patients*

Cited by 3 publications

References 21 publications

Meta‐analysis of the influence of tracheal intubation with cuff and without cuff on the incidence of total wound complications in ICU intubation patients

Meta‐analysis of the influence of tracheal intubation with cuff and without cuff on the incidence of total wound complications in ICU intubation patients

Anticipating Pediatric Post-Extubation Risk: Calling All (North) Stars*

Pre-Extubation Ultrasound Measurement of In Situ Cuffed Endotracheal Tube Laryngeal Air Column Width Difference: Single-Center Pilot Study of Relationship With Post-Extubation Stridor in Subjects Younger Than 5 Years Old

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