Laryngeal ultrasound versus cuff leak test in prediction of post extubation laryngeal edema

Abstract

Endotracheal intubation is indicated in several clinical situations in ICU patients including acute respiratory failure, impending respiratory failure, air way protection in upper airway obstruction or patients at risk for aspiration, most commonly due to altered mental status. In addition, elective intubation is performed for many operative procedures (Griesdale et al., 2008). However, intubation/extubation may lead to the development of complications such as post-extubation stridor laryngeal edema, one of the most frequent causes of reintubation, prolonged mechanical ventilation and increased morbidity in the ICU patients, especially those who are intubated for more than 24 h (Hashemzadeh et al., 2012), (Jaber et al., 2003) Factors associated with the development of post-extubation stridor laryngeal edema include older age, female gender, size of endotracheal tube, presence of cuffed tube, prolonged intubation period, presence of an underlying airway disease, traumatic intubation, tracheal aspiration, tube mobility and patient fighting against the endotracheal tube (Jaber et al., 2003), (Miller and Cole, 1996). Cuff leak test illustrating a leak around the endotracheal tube with the cuff deflated, has been proposed as a simple method of predicting the occurrence of post extubation laryngeal edema. Cuff leak test is measured when the patient presumed ready for extubation, it consists