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2011, Number 4

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Med Crit 2011; 25 (4)

Postextubation stridor and cuff leak volume test in the intensive care unit

Canto ARJ, Macías GMT, Pérez RFJM, Luviano GJA
Full text How to cite this article

Language: Spanish
References: 9
Page: 206-210
PDF size: 81.14 Kb.


Key words:

Extubation, postextubation stridor, cuff leak volume.

ABSTRACT

Objective: To assess the frequency of postextubation stridor in patients with a cuff leak volume ≤ 17%.
Methods: Observational study. In our standard protocol, it was performed a measure of cuff leak volume before extubation. Then, the patients were divided into two groups; those with a cuff leak ≤ 17% (Group A) and those with ≥ 18% (Group B), after that the patients were extubated and observed for presence or abcense of the complication. Statistical analysis was done with X square test.
Results: We studied 103 patients in consecutive manner. 31 had cuff leak volume ≤ 17% and of this 41.9% (13/31) had postextubation stridor. In the 13 patients with the complication, 7 needed emergency intubation.
In the group B we had 72 patients in whom we found a decreased frequency of the complication, being observed in only 4 patients.
The statistical analysis demonstrated both variables cuff leak volume and stridor to be associated with p = 0.005.
Conclusion: In patients with a cuff leak volume ≤ 17% there is an increased frequency of postextubation stridor and an emergency procedure in airway when compared in patients with larger leaks who also showed to have a safer extubation.


REFERENCES

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  2. Divatia J, Bhowmick K. Complications of endotraqueal intubation and other airway management procedures. Indian J Anesth 2005;49:308–318.

  3. ATS: Guidelines for the management of adults with hospital – acquired ventilator, ventilator associated and health care – associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.

  4. Frutos VF, Esteban A. When to wean from a ventilator. An evidence – based strategy. Cleveland Clinic Journal of Medicine 2003;70:389–400.

  5. McIntyre N. Evidence – based guidelines for weaning and discontinuing ventilatory support. Chest 2001;120:375S–395S.

  6. Epstein S. Decision to extubate. Intensive Care Med 2002;28:535–546.

  7. Ho L, Harn H, Lien T, Hu P, Wang J. Postextubation laryngeal edema in adults risk factor evaluation and prevention by hydrocortisone. Intensive Care Med 1996;22:933–936.

  8. Cheng K, Hou C, Huang H, Lin S, Zhang H. Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients. Crit Care Med 2006;34:1345–1350.

  9. Chung Y, Chao T, Chui C, Lin M. The cuff leak test is a simple tool to verify severe laryngeal edema in patients undergoing long-term mechanical ventilation. Crit Care Med 2006;34:409–414.




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Med Crit. 2011;25