Critical appraisal of: The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients. Pediatr Crit Care Med 2008; 9:490-496

To review and discuss the airway leak test in predicting extubation failure in critically ill infants and children. A critical appraisal with literature review of Wratney AT, Benjamin DK Jr, Slonim AD, et al: The endotracheal tube air leak test does not predict extubation outcome in critically ill pediatric patients. Pediatr Crit Care Med 2008; 9:490-496. In this prospective, blinded, cohort study, the authors sought to determine whether the absence of an endotracheal tube airleak (airleak test >30 cm H2O) predicts extubation failure in infants and children. Absence of the airleak did not predict extubation failure. The airleak test was >30 cm H2O before extubation in 47% (28 of 59) of patients, yet 23 patients were extubated successfully (negative predictive value, 18%). An airway leak test >30 cm H2O did not increase the likelihood of postextubation reintubation, with a likelihood ratio of 1.2. The authors found that the positive and negative likelihood ratios for all airway leak test results were between 0.8 and 1.4, thus adding little information for the clinician assessment of extubation readiness. Pediatric patients who are otherwise candidates for extubation but do not have an endotracheal airleak may successfully be extubated.