The Air-Leak Test Is Not a Good Predictor of Postextubation Adverse Events in Children Undergoing Cardiac Surgery

Suominen, Pertti K.; Tuominen, Netta A.; Salminen, Jukka T.; Korpela, Reijo E.; Klockars, Jaakko G.M.; Taivainen, Tomi R.; Meretoja, Olli A.

doi:10.1053/j.jvca.2006.01.007

« Previous Next »Journal of Cardiothoracic and Vascular Anesthesia
Volume 21, Issue 2 , Pages 197-202, April 2007

The Air-Leak Test Is Not a Good Predictor of Postextubation Adverse Events in Children Undergoing Cardiac Surgery

Pertti K. Suominen, MD, PhD
- Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
- Address reprint requests to Pertti Suominen, MD, PhD, Penn State Milton S. Hershey Medical Center, Department of Anesthesiology, 500 University Drive, POB 850, Hershey, PA 17033-0850.
Netta A. Tuominen, MD
- Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
Jukka T. Salminen, MD, PhD
- Department of Paediatric Surgery, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
Reijo E. Korpela, MD
- Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
Jaakko G.M. Klockars, MD
- Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
Tomi R. Taivainen, MD, PhD
- Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
Olli A. Meretoja, MD, PhD
- Department of Anesthesia and Intensive Care, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland

published online 21 April 2006.

Objective: The air-leak test is recommended as a method of assessing the appropriate size of an uncuffed endotracheal tube (ETT) in children. The authors’ primary objective was to determine whether the air-leak test would predict adverse events and reintubations after the removal of the ETT in children who have undergone cardiac surgery.

Design: Prospective, observational, clinical study.

Setting: University tertiary care hospital.

Patients: Ninety-four children <10 years of age undergoing elective cardiac surgery requiring cardiopulmonary bypass surgery.

Interventions: The attending anesthesiologist assessed air-leak pressure after intubation in the operating room (OR). In addition, the air-leak test was performed in 42 patients before extubation in the pediatric intensive care unit (PICU). The incidence of adverse events and the number of failed extubations were recorded after removal of the ETT.

Measurements and Main Results: Eleven of the 94 patients were excluded from the study. Four (4.3%) of the patients died in the PICU before extubation, and 7 patients were excluded for other reasons. The median age of the 83 children was 0.9 years (range 0.01-9.6 years). The total incidences of postextubation adverse events and failed extubations were 30.1% and 8.4%, respectively. An audible air leak ≤25 cmH₂O airway pressure during the OR phase or before removal of the ETT during the PICU recovery phase had no significant predictive value for the incidence of adverse events (p = 0.63) or reintubations (p = 1.0). The patients undergoing simple and complete operations compared with more complex and incomplete operations had significantly fewer postextubation adverse events (p = 0.03). Neonates did not have a higher risk for postextubation adverse events (p = 0.64) or reintubations (p = 0.26) than older children.

Conclusion: The air-leak test did not predict an increased risk for postextubation adverse events and reintubations in children undergoing elective congenital heart surgery.

Key words: intubation, pediatrics, air leak, extubation, congenital heart surgery, cardiopulmonary bypass