How is cuff leak volume measured and interpreted?

Cuff leak: average of the lowest 3 (of 6 consecutive) expired VT readings after cuff deflation minus average expired VT with cuff inflated. Volume <110 mL or <12% of set VT = failed cuff leak test, 19 to 49x increased risk of post-extubation stridor. Meta-analysis: sensitivity 63%, specificity 86% for post-extubation stridor requiring reintubation.

Should corticosteroids be given before extubation after a failed cuff leak test?

Yes. Methylprednisolone 20 mg IV q4h x 4 doses (starting 12h before planned extubation) significantly improves cuff leak and reduces post-extubation stridor (Jaber et al., Lancet 2007). Alternatively, dexamethasone 5 to 10 mg IV q6h x 4 doses before extubation. High-risk patients: cuff leak 7 days, female, re-intubated patient.

Cuff Leak Test for Post-Extubation Stridor Prediction

Calculate cuff leak volume (inspired VT minus expired VT with cuff deflated) to predict post-extubation laryngeal edema. Leak <110 mL or <12% of VT is associated with post-extubation stridor risk.

Use the full interactive calculator below, or

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Frequently Asked Questions

How is cuff leak volume measured and interpreted?

Should corticosteroids be given before extubation after a failed cuff leak test?