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Prediction of post-extubation failure by portable ICU ultrasound

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Stridor and vocal cord oedema are common in ICU patients. Currently, the cuff leak volume test is a standard technique to assess these complications [1, 2]; however, wide variations in terms of its sensitivity and specificity have been demonstrated in many studies. Recently, ultrasound is a promising noninvasive method widely used in ICU patients and allows visualization of the vocal cords and larynx [3]. Thus, we would like to determine the diagnostic accuracy of portable ultrasound for detection of these post-extubation complications.


We conducted a prospective, observational study from December 2010 to September 2011 using portable critical care ultrasound to examine air-column width differences of vocal cords before and after deflation of a endotracheal cuff balloon. All patients also underwent cuff leak volume tests and vocal cord examination by direct video laryngoscopy.


We enrolled 101 patients with planned extubation. The overall prevalence of post-extubation stridor and/or vocal cord oedema was 17%. Age, gender, duration of intubation and BMI were not different between patients with and without post-extubation complications. The average sizes of endotracheal tubes were similar in both groups (No. 7.5). The mean difference of increasing of air-column width in patients without complications was considerably higher than those with complications (1.9 mm vs. 1.1 mm; P < 0.001). The sensitivity and specificity at air-column width differences ≥1.6 mm were 0.706 and 0.702 respectively. The positive predictive value and negative predictive value were 0.324 and 0.922. The area under the ROC curve of tracheal ultrasound was 0.823 (95% CI: 0.698 to 0.947) and that of the cuff leak volume test was 0.840 (95% CI: 0.715 to 0.964).


Portable ICU ultrasound visualising air-column width differences between pre and post deflation cuff balloon is a promising objective tool which aids in prediction of successful extubation.


  1. 1.

    De Bast Y, De Backer D, Moraine JJ, et al.: The cuff leak test to predict failure of tracheal extubation for laryngeal edema. Intensive Care Med 2002, 28: 1267-1272. 10.1007/s00134-002-1422-3

  2. 2.

    Chung YH, Chao TY, Chiu CT, et al.: The cuff-leak test is a simple tool to verify severe laryngeal edema in patients undergoing long-term mechanical ventilation. Crit Care Med 2006, 34: 409. 10.1097/01.CCM.0000198105.65413.85

  3. 3.

    Ding LW, Wang HC, Wu HD, et al.: Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study. Eur Respir J 2006, 27: 384. 10.1183/09031936.06.00029605

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Correspondence to Y Sutherasan.

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Sutherasan, Y., Theerawit, P., Hongpanat, T. et al. Prediction of post-extubation failure by portable ICU ultrasound. Crit Care 16, P130 (2012).

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  • Vocal Cord
  • Objective Tool
  • Video Laryngoscopy
  • Deflation Cuff
  • Successful Extubation