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Modified Cuff Leak Test for Predicting the Risk of Reintubation in Patients with Invasive Mechanical Ventilation: A Multicenter, Single-Blind, Randomized Controlled Trial

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机构： [1]Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine; Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital); Beijing Key Laboratory of Respiratory and Pulmonary Circulation disorders, Beijing, China. [2]Department of Critical Care Medicine, Beijing You'an Hospital, Capital Medical University, Beijing, China. [3]Department of Critical Care Medicine, People's Hospital of Jiangyin City, Jiangyin, Jiangsu province, China. [4]Department of Pulmonary and Critical Care Medicine, Yangquan Coal Industry (Group) General Hospital, Yangquan, Shanxi province, China. [5]Department of Emergency Medicine, General hospital of Ningxia Medical University, Yinchuan, the Ningxia Hui Autonomous Region, China. [6]Intensive care unit, The 910(th) Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Quanzhou, Fujian province, China. [7]Department of Respiratory and Critical Care Medicine, the First affiliated hospital of Guangxi Medical University, Nanning, the Guangxi Zhuang Autonomous Region, China. [8]Intensive care unit, Yunnan University Affiliated Hospital, Kunming, Yunnan province, China. [9]Department of Respiratory and Critical Care Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu province, China. [10]Intensive care unit, the Second Norman Bethune Hospital of Jilin University, Changchun, Jilin province, China. [11]Department of Respiratory and Critical Care Medicine, the Third Hospital of Mianyang, Mianyang, Sichuan province, China. [12]Department of Emergency Medicine, Jinhua People's Hospital, Jinhua, Zhejiang province, China. [13]Department of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai province, China. [14]Department of Respiratory and Critical Care Medicine, Liuzhou People's hospital, Liuzhou, the Guangxi Zhuang Autonomous Region, China. [15]Department of Respiratory and Critical Care Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia Autonomous Region, China. [16]Department of Respiratory and Critical Care Medicine, Dali Bai Autonomous Prefecture People's Hospital, Dali, Yunnan province, China. [17]Department of Respiratory and Critical Care Medicine, Jiangyin Peoples' Hospital, Jiangyin, Jiangsu province, China. [18]Department of Critical Care Medicine, Inner Mongolia Forestry General Hospital, Hulun Buir, Inner Mongolia Autonomous Region, China. [19]Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University (Xibei Hospital), Xi'an, Shaanxi province, China. [20]Intensive care unit, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China. [21]Department of Respiratory and Critical Care Medicine, Kashgar prefecture First People's Hospital, kashgar prefecture, Xinjiang Uygur autonomous region, China. [22]Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, the Ningxia Hui Autonomous Region, China. [23]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China. [24]Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine; Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital); Beijing Key Laboratory of Respiratory and Pulmonary Circulation disorders, Beijing, China. Electronic address: ricusunbing@126.com.

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The cuff leak test (CLT) is an important tool to assess the risk of upper airway obstruction after extubation.Does modified CLT approach have superior ability in predicting re-intubation compared with traditional method?This was a prospective, multicenter, randomized control trial. The primary end point was the incidence of the need for reintubation within 48 h after extubation. The secondary end points were the actual incidence of reintubation, the incidence of post-extubation stridor (PES), and the duration of invasive mechanical ventilation (IMV), etc. RESULT: There were totally 536 patients randomized to either modified CLT group (n = 268) or control group (n = 268). The incidence of reintubation within 48 h after extubation did not differ between the groups. PES within 24 h after extubation was more frequent in the modified CLT group than in the control group (5.22% vs. 1.49%; OR 0.275 [95% CI, 0.089-0.846]; P = 0.028). The IMV duration was shorter in the modified CLT group than in the control group (137 h [74, 218] vs. 159 h [95, 252]; OR 1.001 [95% CI, 1.000-1.002], P = 0.046). In the patients with IMV duration ≥6 days, the incidence of PES was 2.95% in modified CLT group and 0.74% in the control group (OR 0.203 [95% CI, 0.042-0.975], P = 0.048).Compared with the control group, the modified CLT approach might better predict PES within 24 h after extubation, especially for the patients with IMV duration longer than 6 days, but it could not help decrease the reintubation incidence and mortality.GOV: NCT05550220, Registered 19 September 2022.Copyright © 2025. Published by Elsevier Inc.

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医学

小类 | 1 区呼吸系统 2 区危重病医学

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第一作者机构： [1]Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Institute of Respiratory Medicine; Beijing Engineering Research Center for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital); Beijing Key Laboratory of Respiratory and Pulmonary Circulation disorders, Beijing, China.

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