The cuff leak test in critically ill patients: An international survey of intensivists

Kimberley Lewis; Yousef Almubarak; Morten Hylander Møller; Roman Jaeschke; Dan Perri; Ying Zhang; Bin Du; Osamu Nishida; George Ntoumenopoulos; Manoj Saxena; Jonathon Truwit; Paul J Young; Fayez Alshamsi; Yaseen M Arabi; Bram Rochwerg; Tim Karachi; Wojciech Szczeklik; Muhammed Alshahrani; Flavia R Machado; Djillali Annane; Massimo Antonelli; Timothy D Girard; Deborah Cook; Bandar Baw; Rahul Nanchal; Thomas Piraino; Gordon Guyatt; Waleed Alhazzani; GUIDE Group

doi:10.1111/aas.13838

The cuff leak test in critically ill patients: An international survey of intensivists

Kimberley Lewis^*, Yousef Almubarak, Morten Hylander Møller, Roman Jaeschke, Dan Perri, Ying Zhang, Bin Du, Osamu Nishida, George Ntoumenopoulos, Manoj Saxena, Jonathon Truwit, Paul J Young, Fayez Alshamsi, Yaseen M Arabi, Bram Rochwerg, Tim Karachi, Wojciech Szczeklik, Muhammed Alshahrani, Flavia R Machado, Djillali AnnaneMassimo Antonelli, Timothy D Girard, Deborah Cook, Bandar Baw, Rahul Nanchal, Thomas Piraino, Gordon Guyatt, Waleed Alhazzani, GUIDE Group

^*Corresponding author for this work

Department of Intensive Care

7 Citations (Scopus)

Abstract

BACKGROUND: The cuff leak test (CLT) is used to assess laryngeal edema prior to extubation. There is limited evidence for its diagnostic accuracy and conflicting guidelines surrounding its use in critically ill patients who do not have risk factors for laryngeal edema. The primary study aim was to describe intensivists' beliefs, attitudes, and practice regarding the use of the CLT.

METHODS: A 13-item survey was developed, pilot-tested, and subjected to clinical sensibility testing. The survey was distributed electronically through MetaClinician®. Descriptive statistics and multivariable regression analysis were performed to examine associations between participant demographics and survey responses.

RESULTS: 1184 practicing intensivists from 17 countries in North and South America, Europe, Oceania, and Asia participated. The majority (59%) of respondents reported rarely or never perform the CLT prior to extubating patients not at high risk of laryngeal edema, which correlated with 54% of respondents reporting they believed a failed CLT did not predict reintubation. Intensivists from the Middle East were 2.4 times more likely to request a CLT compared to those from North America. Intensivists with base training in medicine or emergency medicine were more likely to request a CLT prior to extubation compared to those with base training in anesthesiology.

CONCLUSION: Use of the CLT prior to extubating patients not at high risk of laryngeal edema in the intensive care unit is highly variable. Practice appears to be influenced by country of practice and base specialty training.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	65
Issue number	8
Pages (from-to)	1087-1094
Number of pages	8
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.13838
Publication status	Published - Sept 2021

Keywords

Critical Illness
Humans
Intensive Care Units
Intubation, Intratracheal/adverse effects
Laryngeal Edema/etiology
Surveys and Questionnaires

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10.1111/aas.13838

Cite this

Lewis, K., Almubarak, Y., Hylander Møller, M., Jaeschke, R., Perri, D., Zhang, Y., Du, B., Nishida, O., Ntoumenopoulos, G., Saxena, M., Truwit, J., Young, P. J., Alshamsi, F., Arabi, Y. M., Rochwerg, B., Karachi, T., Szczeklik, W., Alshahrani, M., Machado, F. R., ... GUIDE Group (2021). The cuff leak test in critically ill patients: An international survey of intensivists. Acta Anaesthesiologica Scandinavica, 65(8), 1087-1094. https://doi.org/10.1111/aas.13838

Lewis, K, Almubarak, Y, Hylander Møller, M, Jaeschke, R, Perri, D, Zhang, Y, Du, B, Nishida, O, Ntoumenopoulos, G, Saxena, M, Truwit, J, Young, PJ, Alshamsi, F, Arabi, YM, Rochwerg, B, Karachi, T, Szczeklik, W, Alshahrani, M, Machado, FR, Annane, D, Antonelli, M, Girard, TD, Cook, D, Baw, B, Nanchal, R, Piraino, T, Guyatt, G, Alhazzani, W & GUIDE Group 2021, 'The cuff leak test in critically ill patients: An international survey of intensivists', Acta Anaesthesiologica Scandinavica, vol. 65, no. 8, pp. 1087-1094. https://doi.org/10.1111/aas.13838

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title = "The cuff leak test in critically ill patients: An international survey of intensivists",

abstract = "BACKGROUND: The cuff leak test (CLT) is used to assess laryngeal edema prior to extubation. There is limited evidence for its diagnostic accuracy and conflicting guidelines surrounding its use in critically ill patients who do not have risk factors for laryngeal edema. The primary study aim was to describe intensivists' beliefs, attitudes, and practice regarding the use of the CLT.METHODS: A 13-item survey was developed, pilot-tested, and subjected to clinical sensibility testing. The survey was distributed electronically through MetaClinician{\textregistered}. Descriptive statistics and multivariable regression analysis were performed to examine associations between participant demographics and survey responses.RESULTS: 1184 practicing intensivists from 17 countries in North and South America, Europe, Oceania, and Asia participated. The majority (59\%) of respondents reported rarely or never perform the CLT prior to extubating patients not at high risk of laryngeal edema, which correlated with 54\% of respondents reporting they believed a failed CLT did not predict reintubation. Intensivists from the Middle East were 2.4 times more likely to request a CLT compared to those from North America. Intensivists with base training in medicine or emergency medicine were more likely to request a CLT prior to extubation compared to those with base training in anesthesiology.CONCLUSION: Use of the CLT prior to extubating patients not at high risk of laryngeal edema in the intensive care unit is highly variable. Practice appears to be influenced by country of practice and base specialty training.",

keywords = "Critical Illness, Humans, Intensive Care Units, Intubation, Intratracheal/adverse effects, Laryngeal Edema/etiology, Surveys and Questionnaires",

author = "Kimberley Lewis and Yousef Almubarak and \{Hylander M{\o}ller\}, Morten and Roman Jaeschke and Dan Perri and Ying Zhang and Bin Du and Osamu Nishida and George Ntoumenopoulos and Manoj Saxena and Jonathon Truwit and Young, \{Paul J\} and Fayez Alshamsi and Arabi, \{Yaseen M\} and Bram Rochwerg and Tim Karachi and Wojciech Szczeklik and Muhammed Alshahrani and Machado, \{Flavia R\} and Djillali Annane and Massimo Antonelli and Girard, \{Timothy D\} and Deborah Cook and Bandar Baw and Rahul Nanchal and Thomas Piraino and Gordon Guyatt and Waleed Alhazzani and \{GUIDE Group\}",

note = "{\textcopyright} 2021 Acta Anaesthesiologica Scandinavica Foundation.",

year = "2021",

month = sep,

doi = "10.1111/aas.13838",

language = "English",

volume = "65",

pages = "1087--1094",

journal = "Acta Anaesthesiologica Scandinavica",

issn = "0001-5172",

publisher = "Blackwell Munksgaard",

number = "8",

}

TY - JOUR

T1 - The cuff leak test in critically ill patients

T2 - An international survey of intensivists

AU - Lewis, Kimberley

AU - Almubarak, Yousef

AU - Hylander Møller, Morten

AU - Jaeschke, Roman

AU - Perri, Dan

AU - Zhang, Ying

AU - Du, Bin

AU - Nishida, Osamu

AU - Ntoumenopoulos, George

AU - Saxena, Manoj

AU - Truwit, Jonathon

AU - Young, Paul J

AU - Alshamsi, Fayez

AU - Arabi, Yaseen M

AU - Rochwerg, Bram

AU - Karachi, Tim

AU - Szczeklik, Wojciech

AU - Alshahrani, Muhammed

AU - Machado, Flavia R

AU - Annane, Djillali

AU - Antonelli, Massimo

AU - Girard, Timothy D

AU - Cook, Deborah

AU - Baw, Bandar

AU - Nanchal, Rahul

AU - Piraino, Thomas

AU - Guyatt, Gordon

AU - Alhazzani, Waleed

AU - GUIDE Group

PY - 2021/9

Y1 - 2021/9

N2 - BACKGROUND: The cuff leak test (CLT) is used to assess laryngeal edema prior to extubation. There is limited evidence for its diagnostic accuracy and conflicting guidelines surrounding its use in critically ill patients who do not have risk factors for laryngeal edema. The primary study aim was to describe intensivists' beliefs, attitudes, and practice regarding the use of the CLT.METHODS: A 13-item survey was developed, pilot-tested, and subjected to clinical sensibility testing. The survey was distributed electronically through MetaClinician®. Descriptive statistics and multivariable regression analysis were performed to examine associations between participant demographics and survey responses.RESULTS: 1184 practicing intensivists from 17 countries in North and South America, Europe, Oceania, and Asia participated. The majority (59%) of respondents reported rarely or never perform the CLT prior to extubating patients not at high risk of laryngeal edema, which correlated with 54% of respondents reporting they believed a failed CLT did not predict reintubation. Intensivists from the Middle East were 2.4 times more likely to request a CLT compared to those from North America. Intensivists with base training in medicine or emergency medicine were more likely to request a CLT prior to extubation compared to those with base training in anesthesiology.CONCLUSION: Use of the CLT prior to extubating patients not at high risk of laryngeal edema in the intensive care unit is highly variable. Practice appears to be influenced by country of practice and base specialty training.

AB - BACKGROUND: The cuff leak test (CLT) is used to assess laryngeal edema prior to extubation. There is limited evidence for its diagnostic accuracy and conflicting guidelines surrounding its use in critically ill patients who do not have risk factors for laryngeal edema. The primary study aim was to describe intensivists' beliefs, attitudes, and practice regarding the use of the CLT.METHODS: A 13-item survey was developed, pilot-tested, and subjected to clinical sensibility testing. The survey was distributed electronically through MetaClinician®. Descriptive statistics and multivariable regression analysis were performed to examine associations between participant demographics and survey responses.RESULTS: 1184 practicing intensivists from 17 countries in North and South America, Europe, Oceania, and Asia participated. The majority (59%) of respondents reported rarely or never perform the CLT prior to extubating patients not at high risk of laryngeal edema, which correlated with 54% of respondents reporting they believed a failed CLT did not predict reintubation. Intensivists from the Middle East were 2.4 times more likely to request a CLT compared to those from North America. Intensivists with base training in medicine or emergency medicine were more likely to request a CLT prior to extubation compared to those with base training in anesthesiology.CONCLUSION: Use of the CLT prior to extubating patients not at high risk of laryngeal edema in the intensive care unit is highly variable. Practice appears to be influenced by country of practice and base specialty training.

KW - Critical Illness

KW - Humans

KW - Intensive Care Units

KW - Intubation, Intratracheal/adverse effects

KW - Laryngeal Edema/etiology

KW - Surveys and Questionnaires

UR - https://www.scopus.com/pages/publications/85108214949

U2 - 10.1111/aas.13838

DO - 10.1111/aas.13838

M3 - Journal article

C2 - 36169641

SN - 0001-5172

VL - 65

SP - 1087

EP - 1094

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 8

ER -

The cuff leak test in critically ill patients: An international survey of intensivists

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Keywords

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