Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients

Inclusion Criteria: * ≥18 yrs. of age * Mechanically ventilated in the ICU \\ * An order to extubate has been provided by the treating physician * Meet at least 1 criteria for risk factors for Laryngeal Edema(LE): * Criteria 1 * Intubated for \>5 days * Criteria 2 \*must fulfill category 1 and ≥1 risk factor in category 2 * Category 1 \- Intubated for \>48 hours * Category 2 * An unplanned extubation event within the last week * Airway trauma secondary to an endotracheal intubation during the past week defined as one of the following: * More than one attempt at direct laryngoscopy * More than one attempt to pass the ETT * Charted as a traumatic intubation * A body mass index of \>30kg/m2 * An endotracheal tube greater than 8mm in a man or 7mm in a woman * A total positive cumulative fluid balance of at least \>1500ml/d x # of days admitted to ICU (eg. If admitted for 4 days, the patient will meet this criterion if they are 6L positive during their length of ICU admission) * Physician concern about possible laryngeal edema for a reason not previously listed above. For example: * Prone or Trendelenburg position in a recent operation * Agitation defined as a RASS of 3+ or more or a SAS of 6 or more that may result in airway injury Exclusion Criteria: * Palliative care plan or plan of care does not include re-intubation, Decision to withdraw life support, or no plan for re-intubation * Known pregnancy: Current pregnancy or up to and including 7 days postpartum * Patients with highly suspected laryngeal injury: Burn patients, smoke inhalation injuries, blunt or penetrating trauma of the neck and airway, recent head and neck surgeries, and patients admitted with airway edema * Known pre-existing tracheolaryngeal abnormalities: Vocal cord paralysis, tracheolaryngeal neoplasm, tracheomalasia, tracheolaryngeal stenosis, or previous head and neck surgeries * Mechanical ventilation via a tracheostomy * High dose steroids administered within the previous 72h (Prednisone 1mg/kg oral equivalent) * The ICU physician believes the patient should have a CLT performed * Patient had a failed CLT in the previous 24 hours