René Dubos Hospital, Pontoise, France.
Respir Care. 2012 Dec;57(12):2026-31. doi: 10.4187/respcare.01527.
This was an evaluation of intra-individual variation of the cuff-leak test (ΔCLT) immediately post-intubation and pre-extubation, as a predictor of post-extubation stridor.
Prospective, clinical investigation in the ICU of a non-university hospital. CLTs were performed immediately after intubation (T0) and before extubation (T1) to evaluate the differences in cuff leak (ΔCLT = CL(T1) - CL(T0)).
We included 104 mechanically ventilated subjects in the study over a 12-month period. The incidence of post-extubation stridor was 6.7%. Stridor was more common in females of short stature. ΔCLT was considered as significant when CL(T1) - CL(T0) was negative. The sensitivity and the specificity of the test were 86% and 48%, respectively. When we tested the pre-extubation CLT alone with a threshold of 130 mL as a predictor of post-extubation stridor, the sensitivity and the specificity of the test were 86% and 76%, respectively.
The intra-individual variation of CLT immediately post-intubation and pre-extubation does not improve the accuracy of a standard pre-extubation CLT to predict post-extubation stridor. Moreover, the standard pre-extubation CLT did not appear in our study to be an ideal test to detect post-extubation stridor. Larger studies should be performed before generalizing these preliminary results.
本研究评估了气管插管即刻和拔管前个体内袖带漏气试验（ΔCLT）的变化，作为拔管后喘鸣的预测指标。
前瞻性、临床研究，在非大学医院的 ICU 进行。在气管插管即刻（T0）和拔管前（T1）进行 CLT，以评估袖带漏气的差异（ΔCLT=CL（T1）-CL（T0））。
我们在 12 个月的时间里纳入了 104 例接受机械通气的患者。拔管后喘鸣的发生率为 6.7%。喘鸣在身材矮小的女性中更为常见。当 CL（T1）-CL（T0）为负值时，认为 ΔCLT 有意义。该试验的敏感性和特异性分别为 86%和 48%。当我们单独使用拔管前 CLT 作为预测拔管后喘鸣的指标，并将其阈值设为 130 mL 时，该试验的敏感性和特异性分别为 86%和 76%。
气管插管即刻和拔管前个体内 CLT 的变化并不能提高标准拔管前 CLT 预测拔管后喘鸣的准确性。此外，在本研究中，标准拔管前 CLT 似乎并不是检测拔管后喘鸣的理想试验。在推广这些初步结果之前，应该进行更大规模的研究。
