@article {Kallet309, author = {Richard H Kallet and Aya Matsushima and Susan Yoo and Michael S Lipnick}, title = {Utilization of a Risk Stratification Tool and Volume-Based Cuff Leak Test to Assess Postextubation Stridor}, volume = {68}, number = {3}, pages = {309--319}, year = {2023}, doi = {10.4187/respcare.10285}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Postextubation 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{\textendash}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 cutoff 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{\textendash}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 48\% had suffered acute brain injury.CONCLUSIONS: Among predominantly surgical-trauma and neurotrauma subjects with a CLT, leak volume of >= 110 mL was associated with a PES risk of \~{}6\%, whereas the risk of PES was 7 times greater when the leak volume was \< 110 mL.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/68/3/309}, eprint = {https://rc.rcjournal.com/content/68/3/309.full.pdf}, journal = {Respiratory Care} }