Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients

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