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Research ArticleOriginal Research

Utilization of a Risk Stratification Tool and Volume-Based Cuff Leak Test to Assess Post-Extubation Stridor

Richard H Kallet, Aya Matsushima, Susan Yoo and Michael S Lipnick
Respiratory Care August 2022, respcare.10285; DOI: https://doi.org/10.4187/respcare.10285
Richard H Kallet
Department of Anesthesia and Perioperative Care University of California, San Francisco at San Francisco General Hospital.
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Aya Matsushima
Department of Anesthesia and Perioperative Care, Respiratory Care Division, University of California, San Francisco at San Francisco General Hospital.
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Susan Yoo
Department of Anesthesia and Perioperative Care University of California, San Francisco at San Francisco General Hospital.
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Michael S Lipnick
Department of Anesthesia and Perioperative Care University of California, San Francisco at San Francisco General Hospital.
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Abstract

Background: Post-extubation stridor (PES) is an imminently life-threatening event. Maximizing patient safety requires a systematic approach to screen patients for PES risk factors and a standardized test to evaluate that risk. This retrospective study of adult subjects was based on quality assurance data including standardized surveillance screening criteria and a volume-based cuff leak test (CLT) to evaluate PES risk among predominantly surgical-trauma and neurotrauma subjects. Data characterizing PES subjects also were collected.

Methods: Data were collected between May 2010 and December 2017 for all intubated subjects in our surgical-trauma, neurotrauma and medical ICUs. Respiratory therapists were trained in performing both PES risk assessment surveillance and a volume-based CLT. A pre-hoc cut-off leak volume of < 110 mL defined a true positive test result when associated with PES and a leak ≥ 110 mL defined a true negative test if PES was absent. Multiple comparisons were analyzed by Kruskal-Wallis tests and dichotomous variables assessed by Fisher exact tests. Alpha was set at 0.05.

Results: In 681 pre-extubation CLTs ∼85% produced true negative results and 15% consisted of: true positive (∼4%), false negative (∼5%), and false positive (∼6%) results. Positive and negative predictive values were 0.42 (0.32-0.54) and 0.94 (0.92-0.96) respectively. The PES likelihood ratio was 7.0 and correct classification was 89%. Of the 115 PES incidences occurring in 112 PES cases 67% were female and 53% had suffered acute brain injury.

Conclusion: Among predominantly surgical-trauma and neurotrauma subjects a CLT leak volume of ≥ 110 mL was associated with a PES risk of ∼6% whereas the risk of PES is 7 times greater when the leak volume is < 110 mL.

  • airway management
  • airway extubation
  • airway obstruction
  • post-extubation stridor
  • cuff leak test
  • laryngeal edema

Footnotes

  • Corresponding Author: Rich Kallet 2070 Fell St. Apt #1 San Francisco, CA. 94117–1878 Email: richkallet{at}gmail.com
  • Received May 16, 2022.
  • Accepted August 15, 2022.
  • Copyright © by Daedalus Enterprises
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Respiratory Care: 68 (10)
Respiratory Care
Vol. 68, Issue 10
1 Oct 2023
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Utilization of a Risk Stratification Tool and Volume-Based Cuff Leak Test to Assess Post-Extubation Stridor
Richard H Kallet, Aya Matsushima, Susan Yoo, Michael S Lipnick
Respiratory Care Aug 2022, respcare.10285; DOI: 10.4187/respcare.10285

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Utilization of a Risk Stratification Tool and Volume-Based Cuff Leak Test to Assess Post-Extubation Stridor
Richard H Kallet, Aya Matsushima, Susan Yoo, Michael S Lipnick
Respiratory Care Aug 2022, respcare.10285; DOI: 10.4187/respcare.10285
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Keywords

  • airway management
  • airway extubation
  • airway obstruction
  • post-extubation stridor
  • cuff leak test
  • laryngeal edema

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