Measurement of leak volume as a diagnostic predictor of post-extubation stridor in pediatric patients
Abstract
Background Endotracheal intubation can cause post-extubation stridor (PES). The PES may prolong the length of stay in the hospital and be associated with increased morbidity and mortality, particularly if re-intubation is necessary. The leak volume (LV) test is a simple method to detect airway edema.
Objective To evaluate the efficacy of LV and percent leak volume (PLV) in predicting PES.
Methods Inspired tidal volume (VTi) and expired tidal volume (VTe) were observed for six respiratory cycles during positive pressure ventilation before extubation. The average of the six VTi and six VTe values were recorded. The LV was the difference between average VTi and average VTe. The conversion of the ratio of LV to average VTi into percentage was defined as PLV. Both LV and PLV were analyzed to determine cut-off values in predicting PES.
Results Among 77 patients, 39 patients (50.6%) developed PES. Both LV and PLV showed a significant decrease in patients with PES.The ROC analysis showed that LV at a cut-off point of < 18.34 ml gave a sensitivity of 82.1% and specificity of 57.9%, whereas PLV < 13.83% yielded 79.5% sensitivity and 57.9% specificity for predicting PES. The LV and PLV had an area under the ROC curve of 0.770 (95%CI 0.665 to 0.874; P<0.001) and 0.706 (95%CI 0.59 to 0.821; P=0.01) respectively.
Conclusion Leak volume and percent leak volume can be used as markers to predict PES in pediatric patients.
References
2. Wittekamp BH, van MooK WN, Tjan DH, Zwaveling JH, Bergmans DC. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009; 13:233. DOI: https://doi.org/10.1186/cc8142
3. Zhou T, Zhang HP, Chen WW, Xiong ZY, Fan T, Fu JJ, et al. Cuff-leak test for predicting post-extubation airway complications: A systematic review. J Evid Based Med. 2011; 4: 242-54. DOI: https://doi.org/10.1111/j.1756-5391.2011.01160.x
4. Wratney AT, Benjamin Jr DK, Slonim AD, He J, Hamel DA, Cheifetz IM. The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients. Pediatr Crit Care Med. 2008; 9: 490-6. DOI: https://doi.org/10.1097/PCC.0b013e3181849901
5. Thachil TJ, Kuriakose BK, Nayak VR, Khadke V. Cuff leak test for predicting post extubation stridor in intubated adult patients – A prospective observational study. Indian J Public Health Res Dev. 2021; 12: 518-22. DOI: https://doi.org/10.37506/ijphrd.v12i3.16120
6. Kuriyama A, Jackson JL, Kamei J. Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis. Crit Care 2020; 24: 640. DOI: https://doi.org/10.1186/s13054-020-03358-8
7. Mhanna MJ, Yaacov BZ, Tichy CM, Super DM. The “air leak” test around the endotracheal tube, as a predictor of post-extubation stridor, is age dependent in children. Critical Care Medicine. 2002; 30: 2639-43. DOI: https://doi.org/10.1097/00003246-200212000-00005
8. Seid AB, Godin MS, Pransky SM, Kearns DB, Peterson BM. The prognostic value of endotracheal tube-air leak following tracheal surgery in children. Arch Otolaryngol Head Neck Surg 1991; 117:880-2. DOI: https://doi.org/10.1001/archotol.1991.01870200074011
9. Finholt DA, Henry DB, Raphaely RC. Factors affecting leak around tracheal tubes in children. Can Anaesth Soc J 1985; 32: 326-9. DOI: https://doi.org/10.1007/bf03011335
10. Amrousy DE, Elkashlan M, Elshmaa N, Ragab A. Ultrasound-guided laryngeal air column width difference as a new predictor for postextubation stridor in children. Crit Care Med. 2018; 46: e496-e501. DOI: https://doi.org/10.1097/ccm.0000000000003068
11. Ding L, Wang H, Wu HD, Chang C, Yang P. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study. Eur Respir J 2006; 27: 384-9. DOI: https://doi.org/10.1183/09031936.06.00029605
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Accepted 2024-10-14
Published 2024-10-14
