Is the Leak Test Reproducible?
Background. The leak test is an accepted practice for evaluating airway edema and patient readiness for extubation. Reproducibility and interobserver reliability for this test have not been established. We studied the reproducibility and reliability of the leak test in and among health care professionals.
Methods. Thirteen consecutive intubated patients were tested in triplicate and in blinded fashion by three observers to determine the leak around the endotracheal tube before extubation. All patients were pharmacologically paralyzed and sedated before assessment.
Results. Neither interobserver or intraobserver variability was statistically significant when a standardized method was used to determine the leak.
Conclusion. The leak test is reliable by the same or different observers regardless of varied clinical experience when using a standardized approach to measuring the leak.

Postextubation stridor and clinical evidence of upper airway obstruction is a commonly encountered problem in the pediatric intensive care unit (PICU). Tracheal extubation in pediatric patients with airway edema or obstruction is a potentially life-threatening event. The reported incidence of stridor related to intubation varies widely, from a low of 1% in the medical/ surgical population to a high of 37% in pediatric trauma patients who are admitted to intensive care. The leak test is a method proposed to determine the appropriateness of endotracheal tube size and whether patients can be extubated without development of stridor and upper airway obstruction. The test has also been used as a criterion for elective extubation of children with laryngotracheobronchitis.

When done in the awake, agitated, or coughing patient, this test can lead to erroneous results. The accuracy of measurement is increased in the sedated and pharmacologically paralyzed patient. Reproducibility and interobserver reliability in medical/surgical pediatric intensive care patients has not been established. Our prospective study was designed to ascertain whether the leak test is reproducible in and among health care professionals with different levels of training and experience.