Q: What is the appropriate way to qualitatively assess the cuff leak in an intubated patient?
Answer: A plethora of literature is available to assess cuff leaks in an intubated patient quantitatively. Qualitative assessment of cuff leaks depends mostly on the clinician's experience. One reliable way is to deflate the endotracheal tube's (ETT) cuff, put the stethoscope over the upper anterior neck (upper trachea), and listen for the air movement around the ETT.
Said that all cuff leaks should be ideally quantified. Laryngeal edema, laryngeal stenosis, excess of tracheal secretions, and a large diameter ETT are the usual reasons for decreased or absent cuff leak.
Extubation is a clinical decision and more of an art than a science.
References:1. Kuriyama A, Jackson JL, Kamei J. Performance of the cuff leak test in adults in predicting post-extubation airway complications: a systematic review and meta-analysis. Crit Care. 2020 Nov 7;24(1):640. doi: 10.1186/s13054-020-03358-8. PMID: 33160405; PMCID: PMC7648377.