Clinicians perform the cuff leak test (CLT) to help optimize extubation. The test requires deflation of the cuff at the end of the endotracheal tube (ETT) and auscultation for air passing around the ETT. If air movement is not audible on auscultation (a failed CLT) there is a potential presence of laryngeal edema (LE) that may cause post-extubation airway obstruction. Approximately 4-55% of mechanically ventilated ICU patients will have some degree of LE and upwards of 50% of those patients will require emergent reintubation for airway protection. Predicting patients that are unsuitable for extubation is important as reintubation itself is associated with increased morbidity and mortality.

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While the CLT is a simple, non-invasive, and inexpensive test, its diagnostic accuracy, and therefore clinical applicability, remains uncertain. A failed CLT and presumptive diagnosis of LE is often treated with systemic corticosteroids and a delay in extubation. Therefore, a false positive test will result in an unnecessary delay in extubation. Current guidelines reflect the uncertainty in the evidence. The American Thoracic Society issued a conditional recommendation based on very low certainty of evidence to perform a CLT on those with risk factors for LE.