J Med Assoc Thai 2008; 91 (5):648

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Risk Factors Evaluation and the Cuff Leak Test as Predictors for Postextubation Stridor
Sukhupanyarak S Mail

Objective: To determine the risk factors and the cuff-leak test for predicting postextubation stridor.

Material and Method: A prospective, clinical investigation in 543 patients in intensive care units at
Buddhachinaraj Hospital, a 908-bed hospital in Thailand, with patients who were considered by their physician
to extubate the endotracheal tube. The cuff leak test was done and recorded as presence of leak or absence of
leak. After extubation, postextubation stridor and reintubation were determined.

Results: Of the 543 patients studied, 26(4.8%) had postextubation stridor, 45(8.3%) required reintubation,
21(80.8%) of 26 patients with postextubation stridor required reintubation, and 21(46.7%) of 45 reintubated
patients had postextubation stridor. Postextubation stridor was associated with female, asthmatic patients,
patients with excessive tube mobility due to insufficient fixation, and those who were fighting against the tube.
Twenty-eight out of 543 patients had absence of leak. The absence of leak was observed in four (15.4%) of 26
patients with postextubation stridor and 24 (4.6%) of 517 patients without postextubation stridor. The sensitivity
and the specificity of the cuff leak test were 15.4% and 95%, respectively. The positive and negative predictive
values were 14.3% and 95.7%, respectively.

The method of cuff leak test in the present study is not a good predictor for extubation with
postextubation stridor. Risk factors for developing postextubation stridor are female, asthma, excessive tube
mobility due to insufficient fixation, and fighting against the tube.

Keywords: Cuff leak test, Postextubation stridor, Reintubation

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