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Antonaglia V.,Laboratory of Respiratory Biomechanics | Vergolini A.,Laboratory of Respiratory Biomechanics | Pascotto S.,Laboratory of Respiratory Biomechanics | Bonini P.,University of Trieste | And 4 more authors.
European Journal of Anaesthesiology

Background and objective The objectives of the present study were to evaluate the relationships between the results of the cuff-leak test and the presence of laryngeal lesions; to assess hether lesions needing pharmacological treatment and surveillance can be predicted by the cuff-leak test; and to analyse the relationships between these lesions and postextubation stridor. Methods The present study is a preliminary, prospective, clinical nvestigation set in an 11-bed ICU of a university hospital. We studied 50 consecutive adult patients admitted to the ICU and mechanically ventilated for more than 72 h. All patients underwent cuff-leak test before extubation. A laryngoscopic nspection was performed after extubation to evaluate the presence and degrees of laryngeal lesions. Laryngeal lesionswere classified according to a 5-degree scale (0-4); patients with clinical manifestations were pharmacologically treated and monitored. Results A threshold cuff-leak value of 0.07 l (21% of tidal volume) was determined by visual inspection of the receiveroperating haracteristic plot. Patients were divided into a ositive and a negative cuff-leak test group. Comparing the severity of laryngeal lesions to the cuff-leak test, a relationship between higher degrees of lesions (degrees 3-4) and the positivity of the cuff-leak test (31.3% in the positive cuff-leak test group vs. 3.8% in the negative cuff-leak test group; P=0.023) was observed. The positive and the negative predictive values ere 25 and 96.1%, respectively. Only two cases of postextubation stridor were found, one in each group. There was no correlation between the results of the cuff-leak test and the occurrence of postextubation acute respiratory difficulties.onclusion Cuff-leak test is a simple, noninvasive tool, which may be useful to exclude, in patients with prolonged intubations, the presence of laryngeal injuries needing medical treatment and lose monitoring. This occurs independently of postextubation tridor. © 2010 Copyright European Society of Anaesthesiology. Source

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