Association Between Cuff Leak Test Results and Reintubation Risk: A Retrospective Analysis.

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

SHOCK Pub Date : 2025-07-08 DOI:10.1097/SHK.0000000000002674

Jiawang Cao, Qing Liu, Zhaojin Wang, Yanmei Gu

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引用次数: 0

Abstract

Background: Post-extubation airway obstruction represents a significant complication in critical care, potentially necessitating reintubation and prolonging intensive care unit (ICU) stay. The cuff leak test (CLT) is commonly used to predict post-extubation stridor and reintubation risk, but its clinical utility remains controversial. This study evaluated the relationship between CLT results and reintubation risk in a large cohort of critically ill patients.

Methods: This single-center, retrospective, descriptive study analyzed 742 adult patients admitted to the medical and surgical ICUs who underwent mechanical ventilation for ≥24 hours between January 2020 and December 2024. The primary outcome was reintubation within 48 hours of planned extubation. Quantitative cuff leak volume measurements were performed pre-extubation, with leak volume expressed as absolute values and percentage of tidal volume. Multivariable logistic regression was used to identify independent predictors of reintubation, including CLT results and patient characteristics.

Results: Of the 742 patients studied, 68 (9.2%) required reintubation within 48 hours. Patients with a cuff leak volume < 110 mL or < 15% of tidal volume had significantly higher reintubation rates (18.7% vs. 7.1%, p < 0.001). After adjusting for confounding variables, a positive CLT (defined as cuff leak volume < 110 mL) remained independently associated with reintubation (adjusted OR 2.86, 95% CI 1.65-4.97, p < 0.001). Other significant independent predictors included prolonged intubation (>7 days), female sex, body mass index >30 kg/m2, and traumatic or difficult intubation. Combining CLT results with these clinical risk factors improved prediction accuracy (AUC 0.82, 95% CI 0.76-0.87).

Conclusion: A positive cuff leak test is independently associated with increased reintubation risk in critically ill patients. The predictive accuracy is enhanced when CLT results are combined with clinical risk factors. These findings suggest that CLT should be incorporated into extubation decision-making, particularly for patients with additional risk factors for post-extubation airway complications.

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袖带泄漏试验结果与再插管风险之间的关系：回顾性分析。

背景：拔管后气道阻塞是重症监护的一个重要并发症，可能需要重新插管并延长重症监护病房（ICU）的住院时间。袖带泄漏试验（CLT）通常用于预测拔管后喘鸣和再插管风险，但其临床应用仍存在争议。本研究评估了大量危重患者CLT结果与再插管风险之间的关系。方法：这项单中心、回顾性、描述性研究分析了2020年1月至2024年12月期间入住内科和外科icu并接受机械通气≥24小时的742例成年患者。主要结果是在计划拔管后48小时内重新插管。拔管前定量测量袖套漏气量，漏气量以绝对值和占潮气量的百分比表示。多变量逻辑回归用于确定再插管的独立预测因素，包括CLT结果和患者特征。结果：在研究的742例患者中，68例（9.2%）在48小时内需要重新插管。袖带漏气量< 110 mL或<潮气量15%的患者的再插管率明显较高（18.7% vs. 7.1%, p < 0.001）。在调整混杂变量后，阳性CLT（定义为袖带漏气量< 110 mL）仍然与再插管独立相关（调整OR 2.86, 95% CI 1.65-4.97, p < 0.001）。其他重要的独立预测因素包括插管时间延长（7天）、女性性别、体重指数>30 kg/m2、创伤性或插管困难。将CLT结果与这些临床危险因素结合可提高预测准确性（AUC 0.82, 95% CI 0.76-0.87）。结论：袖带漏试验阳性与危重患者再插管风险增加独立相关。当CLT结果与临床危险因素相结合时，预测准确性得到提高。这些发现表明，CLT应纳入拔管决策，特别是对于有拔管后气道并发症额外危险因素的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

SHOCK 医学-外科

CiteScore

6.20

自引率

3.20%

发文量

199

审稿时长

1 months

期刊介绍： SHOCK®: Injury, Inflammation, and Sepsis: Laboratory and Clinical Approaches includes studies of novel therapeutic approaches, such as immunomodulation, gene therapy, nutrition, and others. The mission of the Journal is to foster and promote multidisciplinary studies, both experimental and clinical in nature, that critically examine the etiology, mechanisms and novel therapeutics of shock-related pathophysiological conditions. Its purpose is to excel as a vehicle for timely publication in the areas of basic and clinical studies of shock, trauma, sepsis, inflammation, ischemia, and related pathobiological states, with particular emphasis on the biologic mechanisms that determine the response to such injury. Making such information available will ultimately facilitate improved care of the traumatized or septic individual.