The Use of the Cuff Leak Test in the Intensive Care Unit: International Survey
CCCF ePoster library. Lewis K. Nov 9, 2018; 233371; 92
Dr. Kim Lewis
Dr. Kim Lewis
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Introduction/Background: Endotracheal intubation and mechanical ventilation are lifesaving interventions. However, as with most acute intervention, it can be associated with serious complications including laryngeal edema (LE) that may result in postextubation stridor and respiratory distress. A cuff leak test (CLT) is a screening test for LE performed prior to extubation. Given the conflicting evidence on the utility of the CLT, it is expected that practice is variable (1-3). There are no published surveys that examine the beliefs, practice habits, and attitudes of intensivists with regards to the use of the CLT in patients with an average risk of laryngeal edema that are admitted to the intensive care unit (ICU).

Objectives: To describe the beliefs, attitudes, and practice variation of intensivists with regards to the utility and accuracy of the CLT in critically ill patients that are at an average risk of laryngeal edema. 

Methods: We created a 13-question survey detailing the clinical use and beliefs of the CLT in average risk patients for laryngeal edema. We pilot-tested the survey and subjected the questions to rigorous clinical sensibility testing. The survey was then distributed electronically to practicing critical care physicians in 17 different countries with the use of MetaClinician platform. 

Results: 1199 practicing intensivists from 17 countries (in North and South America, Europe, and Asia) completed the survey, majority of which (56.1%) practiced critical care for more than 10 years. Overall, the majority of respondents (64%) consider lack of audible leak after cuff deflation as a failed CLT. About 59% of intensivists rarely or never perform the CLT prior to extubation. The use of systemic steroid in patients who failed CLT was highly variable, 38.1% use steroids routinely or most of the time, 46.5% rarely or never use steroids. Similarly, delaying extubation in response to a failed CLT is also highly variable practice. 

Conclusion: There is considerable clinical equipoise on the utility and the response to the results of the CLT prior to extubating patients in the ICU.

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