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Cuff leak tests provide clinicians with information about upper airway narrowing and may help predict weaning success. However, most clinical trials reporting this measurement are small, and the utility of this test remains uncertain. We identified all clinical studies using cuff leak tests in the PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials databases using multiple search terms, including cuff leak test, laryngeal edema, extubation, and stridor, and abstracted quantitative information on cuff leaks and outcomes (stridor and reintubation). We reviewed six studies which included 958 patients with acute respiratory failure in intensive care units. Eighty-two patients (8.5%) had postextubation stridor. The weighted mean cuff leak was 119 (±51) mls in the patients with stridor and 313 (±24) mls in patients without stridor (P<0.01). Sixty-six patients required reintubation. The presence of stridor had a sensitivity of 0.60 (95% CI 0.48-0.72), a specificity of 0.96 (95% CI 0.94-0.97), and a positive likelihood ratio of 13.4 (95% CI 6.9-25.7) for predicting reintubation. No single clinical parameter consistently predicted stridor. Patients with postextubation stridor have smaller cuff leak volumes than patients who do not have stridor and are more likely to require reintubation. Cuff leak measurements can improve decision making with extubation protocols.
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