Beigmohammadi Mohammad Taghi, Amoozadeh Laya, Alipour Abbas
Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran.
Ann Med Surg (Lond). 2022 Sep 22;82:104759. doi: 10.1016/j.amsu.2022.104759. eCollection 2022 Oct.
Improvement of predictive tools for recognition of airway edema is crucial for safe extubation and patient safety. This study aimed to evaluate the diagnostic accuracy of the Gargle test (GT) as a new test for assessing airway edema and predicting successful extubation in patients admitted to the intensive care unit (ICU).
In this prospective observational study, patients underwent head and neck surgeries and admitted to ICU included. All the patients were weaned based on the same protocol.Quantitative Cuff Leak Test (CLT) and qualitative CLTwere first applied followed by GT with normal saline 0.9%. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated.
One hundred and eighteen (male 67, female 51) participated in this study. The agreement between GT and CLT was low (Kappa: quantitative CLT 0.07, qualitative CLT 0.21). The GT compared to CLT had higher sensitivity (33.3% vs 16.6%), specificity (96.3% vs qualitative CLT 92.8%, quantitative CLT 79.4%), PPV (33.3% vs qualitative CLT 11.11%, quantitative CLT 4.0%), NPV (96.3% vs qualitative CLT 95.4%, quantitative CLT 94.6%), and accuracy (92.92% vs qualitative CLT 88.98%, quantitative CLT 76.27%. The cut-off value for GT was estimated 16.5% (sensitivity 74.1% and specificity 60%).
The GT is a simple accurate test and can be used as a new test in the ICU for recognition of airway edema and prediction of safe extubation in patients with head and neck surgeries.
改进用于识别气道水肿的预测工具对于安全拔管和患者安全至关重要。本研究旨在评估漱口试验（GT）作为一种评估气道水肿和预测重症监护病房（ICU）患者成功拔管的新试验的诊断准确性。
在这项前瞻性观察性研究中，纳入接受头颈手术并入住ICU的患者。所有患者均按照相同方案进行撤机。首先应用定量套囊漏气试验（CLT）和定性CLT，然后用0.9%生理盐水进行GT。计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性。
118名患者（男性67名，女性51名）参与了本研究。GT与CLT之间的一致性较低（kappa值：定量CLT为0.07，定性CLT为0.21）。与CLT相比，GT具有更高的敏感性（33.3%对16.6%）、特异性（96.3%对定性CLT的92.8%、定量CLT的79.4%）、PPV（33.3%对定性CLT的11.11%、定量CLT的4.0%）、NPV（96.3%对定性CLT的95.4%、定量CLT的94.6%）和准确性（92.92%对定性CLT的88.98%、定量CLT的76.27%）。GT的截断值估计为16.5%（敏感性74.1%，特异性60%）。
GT是一种简单准确的试验，可作为ICU中用于识别气道水肿和预测头颈手术患者安全拔管的新试验。
