When to extubate the croup patient: the “leak” test

Adderley, Robert J.; Mullins, Geoffrey C.

doi:10.1007/bf03015171

Cited by 50 publications

(31 citation statements)

References 6 publications

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“…Adderley and Mullins[42] using “Qualitative cuff leak test” during a croup epidemic, found that 38% patients with absence of leak, required reintubation. The premise is that with endotracheal tube cuff deflated air leak will occur.…”

Section: Parameters Assessing Airway Patencymentioning

confidence: 99%

Extubation failure in intensive care unit: Predictors and management

Kulkarni

Agarwal

2008

Indian Journal of Critical Care Medicine

111

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Extubation failure-need for reintubation within 72 h of extubation, is common in intensive care unit (ICU). It can cause increased morbidity, higher costs, higher ICU and hospital length of stay (LOS) and mortality. Patients with advanced age, high severity of illness at ICU admission and extubation, preexisting chronic respiratory and cardiovascular disorders are at increased risk of extubation failure. Unresolved illness, development and progression of organ failure during the time from extubation to reintubation and reintubation itself have been proposed as reasons for increased morbidity and mortality. Parameters used to predict extubation failure can be categorized into parameters assessing respiratory mechanics, airway patency and protection and cardiovascular reserve. Adequate cough strength, minimal secretions and alertness are necessary for successful extubation. Evidence suggests that early institution of non-invasive ventilation and prophylactic administration of methylprednisolone may prevent reintubation in some patients. The intensivist needs to identify patients at high risk of extubation failure and be prepared to reinstitute ventilation early to prevent adverse outcomes.

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Section: Parameters Assessing Airway Patencymentioning

confidence: 99%

Extubation failure in intensive care unit: Predictors and management

Kulkarni

Agarwal

2008

Indian Journal of Critical Care Medicine

111

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“…Assessment of airway patency prior to tube removal is challenging. Absence of an audible air leak after deflation of the endotracheal tube balloon (qualitative cuff leak test) has been associated with an increased risk of post-extubation stridor [105,106,107], but the subjective nature of the test is a limiting factor. Another approach is indirect measurement of the volume of gas escaping around the tube during balloon deflation.…”

Section: Weaning Parametersmentioning

confidence: 99%

Decision to extubate

2002

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The need for reintubation within 24-72 h of planned extubation is a common event, occurring in 2-25% of extubated patients. Risk factors for extubation failure include being a medical, multidisciplinary or paediatric patient; age >70 years; a longer duration of mechanical ventilation; use of continuous intravenous sedation; and anaemia (haemoglobin <10 g/dl or haematocrit <30%) at the time of extubation. The pathophysiology of extubation failure can be distinct from that seen with weaning failure and includes upper airway obstruction, inadequate cough, excess respiratory secretions, encephalopathy, and cardiac dysfunction. Extubation failure prolongs the duration of mechanical ventilation, increases the length of ICU and hospital stay, increases the need for tracheostomy, and is associated with a higher hospital mortality. Great emphasis has been placed on accurately predicting extubation outcome because extubation delay is also associated with increased length of stay and mortality. Tests designed to assess for upper airway obstruction, secretion volume, and the effectiveness of cough seem most promising for improving the decision to extubate. Mortality increases with delays in reintubation for patients failing extubation. Timely identification of patients at elevated risk of extubation failure followed by rapid re-establishment of ventilatory support can improve outcome.

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“…Adderley and Mullins [18] first used this test to predict successful extubation in children with croup. In this study successful extubation was likely if an air leak could be heard when the baby coughed during positive pressure ventilation with a plateau pressure of 40 cmH 2 O.…”

Section: Introductionmentioning

confidence: 99%