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The Role of the Cuff Leak Test in Predicting the Effects of Corticosteroid Treatment on Postextubation Stridor

Keywords: postextubation stridor , laryngeal edema , endotracheal intubation , corticosteroid , extubation failure , cuff leak test.

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Background: There is not enough evidence to determine the most appropriate treatment ofpostextubation stridor. Although the cuff leak test is a simple method to predictpostextubation stridor, little is known about its use in monitoring theeffects of steroid treatment for this complication. The aim of this study wasto evaluate the effect of steroids on postextubation stridor based on the clinicalresponse and the cuff leak test.Methods: A cohort of 110 translaryngeal intubated patients in the medical intensivecare unit (ICU) were enrolled. A cuff leak test was conducted before extubation.Patients developing postextubation stridor were intravenously given 5mgs of dexamethasone every 8 hours for 3 days. The clinical response andcuff leak volume before and after steroid treatment were gathered for analysis.Results: The incidence of postextubation stridor was 18.2% (20/110). Fifty-five percentof patients (11/20) with stridor needed reintubation. Overall, 80% ofpatients (16/20) with postextubation stridor improved with steroid treatment.The leak volume significantly increased after treatment (152.4 109.6 mlvs. 29.9 35.7 ml, p = 0.012); stridor did not recur in 64% of reintubatedpatients (7/11). A threshold leak volume of less than 88 ml predicted theoccurrence of stridor (positive predictive value, 54.5%; negative predictivevalue, 90.9%). Postextubation stridor was associated with the female genderand lower leak volumes (p = 0.007 and 0.003, respectively).Conclusion: Corticosteroids improve postextubation stridor. The cuff leak test accuratelypredicts the absence of stridor and is a non-invasive method of monitoringfor regression of laryngeal edema after steroid treatment. Steroid treatmentshould be considered for patients developing postextubation stridor.


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