Cuff-leak test for the diagnosis of upper airway obstruction in adults: a systematic review and meta-analysis

Purpose To evaluate, in adults, the diagnostic accuracy of the cuff-leak test for the diagnosis of upper airway obstruction secondary to laryngeal edema and for reintubation secondary to upper airway obstruction. Methods Systematic review without language restrictions based on electronic databases and manual review of the literature up to December 2008. When appropriate, a random-effects meta-analysis and meta-regression (Moses’ method) were performed. Results Upper airway obstruction was the outcome in nine studies with an overall incidence of 6.9%. There was significant heterogeneity among studies. The pooled sensitivity was 0.56 (95% confidence interval: 0.48–0.63), the specificity was 0.92 (95% CI: 0.90–0.93), the positive likelihood ratio was 5.90 (95% CI: 4.00–8.69), the negative likelihood ratio was 0.48 (95% CI: 0.33–0.72), and the diagnostic odds ratio was 18.78 (95% CI: 7.36–47.92). The area under the curve of the summary receiver-operator characteristic (SROC) was 0.92 (95% CI: 0.89–0.94). Only three studies have evaluated the accuracy of the cuff-leak test for reintubation secondary to upper airway obstruction. Overall incidence was 7%. The pooled sensitivity was 0.63 (95% CI: 0.38–0.84), the specificity was 0.86 (95% CI: 0.81–0.90), the positive likelihood ratio was 4.04 (95% CI: 2.21–7.40), the negative likelihood ratio was 0.46 (95% CI: 0.26–0.82), and the diagnostic odds ratio was 10.37 (95% CI: 3.70–29.13). Conclusions A positive cuff-leak test (absence of leak) should alert the clinician of a high risk of upper airway obstruction.