Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients

Participation Requirements

• Sex:

  ALL

• Eligible Ages:

  18 and up

Participation Criteria

Inclusion Criteria:

* ≥18 yrs. of age
* Mechanically ventilated in the ICU \\
* An order to extubate has been provided by the treating physician
* Meet at least 1 criteria for risk factors for Laryngeal Edema(LE):
* Criteria 1
* Intubated for \>5 days
* Criteria 2 \*must fulfill category 1 and ≥1 risk factor in category 2
* Category 1

- Intubated for \>48 hours
* Category 2

* An unplanned extubation event within the last week
* Airway trauma secondary to an endotracheal intubation during the past week defined as one of the following:
* More than one attempt at direct laryngoscopy
* More than one attempt to pass the ETT
* Charted as a traumatic intubation
* A body mass index of \>30kg/m2
* An endotracheal tube greater than 8mm in a man or 7mm in a woman
* A total positive cumulative fluid balance of at least \>1500ml/d x # of days admitted to ICU (eg. If admitted for 4 days, the patient will meet this criterion if they are 6L positive during their length of ICU admission)
* Physician concern about possible laryngeal edema for a reason not previously listed above. For example:
* Prone or Trendelenburg position in a recent operation
* Agitation defined as a RASS of 3+ or more or a SAS of 6 or more that may result in airway injury

Exclusion Criteria:

* Palliative care plan or plan of care does not include re-intubation, Decision to withdraw life support, or no plan for re-intubation
* Known pregnancy: Current pregnancy or up to and including 7 days postpartum
* Patients with highly suspected laryngeal injury: Burn patients, smoke inhalation injuries, blunt or penetrating trauma of the neck and airway, recent head and neck surgeries, and patients admitted with airway edema
* Known pre-existing tracheolaryngeal abnormalities: Vocal cord paralysis, tracheolaryngeal neoplasm, tracheomalasia, tracheolaryngeal stenosis, or previous head and neck surgeries
* Mechanical ventilation via a tracheostomy
* High dose steroids administered within the previous 72h (Prednisone 1mg/kg oral equivalent)
* The ICU physician believes the patient should have a CLT performed
* Patient had a failed CLT in the previous 24 hours