The role of the cuff leak test in predicting the effects of corticosteroid treatment on postextubation stridor.

Background: There is not enough evidence to determine the most appropriate treatment of postextubation stridor. Although the cuff leak test is a simple method to predict postextubation stridor, little is known about its use in monitoring the effects of steroid treatment for this complication. The aim of this study was to evaluate the effect of steroids on postextubation stridor based on the clinical response and the cuff leak test.

Methods: A cohort of 110 translaryngeal intubated patients in the medical intensive care unit (ICU) were enrolled. A cuff leak test was conducted before extubation. Patients developing postextubation stridor were intravenously given 5 mgs of dexamethasone every 8 hours for 3 days. The clinical response and cuff leak volume before and after steroid treatment were gathered for analysis.

Results: The incidence of postextubation stridor was 18.2% (20/110). Fifty-five percent of patients (11/20) with stridor needed reintubation. Overall, 80% of patients (16/20) with postextubation stridor improved with steroid treatment. The leak volume significantly increased after treatment (152.4 +/- 109.6 ml vs. 29.9 +/- 35.7 ml, p = 0.012); stridor did not recur in 64% of reintubated patients (7/11). A threshold leak volume of less than 88 ml predicted the occurrence of stridor (positive predictive value, 54.5%; negative predictive value, 90.9%). Postextubation stridor was associated with the female gender and lower leak volumes (p = 0.007 and 0.003, respectively).

Conclusion: Corticosteroids improve postextubation stridor. The cuff leak test accurately predicts the absence of stridor and is a non-invasive method of monitoring for regression of laryngeal edema after steroid treatment. Steroid treatment should be considered for patients developing postextubation stridor.