European Spine Journal

, Volume 26, Issue 3, pp 840–846 | Cite as

Cuff-leak test combined with interventional bronchoscopy benefits early extubation for patients who received tarp surgery

  • Jian-qiang Dai
  • Wei-Feng Tu
  • Qing-shui Yin
  • Hong Xia
  • Guo-dong Zheng
  • Liang-da Zhang
  • Xian-hua Huang
Original Article



This study explored the performance characteristics of a cuff-leak test (CLT) combined with interventional fiberoptic bronchoscopy (FBS) for evaluating whether early nasoendotracheal extubation was possible for patients who had received transoral atlantoaxial reduction plate (TARP) internal fixation surgery.


318 patients who underwent surgery were retrospectively analyzed (between January 2006 and December 2012). Extubation was performed by conventional approach (CA group, until December 2008) and improved approach (IA group, from January 2009) including CLT and an interventional FBS procedure. The extubation success within 1–3 days after surgery, incidence of postextubation stridor and tracheal reintubation were examined.


More IA-treated patients experienced extubation during the first 2 days than those CA-treated, median extubation time was 3 (2, 3) days in the CA group and 2 (1, 2) days in the IA group (all P < 0.01). The incidence of stridor and reintubation was 5.69 and 0.57 % in IA and 11.98 and 4.93 % in CA, respectively (both P < 0.05). For the CLT-positive patients in the IA group that remained intubated until day 3–4, interventional FBS was applied for safe extubation and achieved 100 % success.


Early extubation through IA is safe and interventional FBS assists successful extubation for CLT-positive patients who underwent TARP surgery.


TARP Cuff-leak test Fiberoptic bronchoscopy Nasoendotracheal extubation Stridor and tracheal reintubation 



Transoral atlantoaxial reduction plate


Nasoendotracheal tube


Cuff-leak test


Fiberoptic bronchoscopy


Conventional approach


Improved approach


Oxygen saturation measured by pulse oximetry

M ± SD

Mean ± standard deviation


Statistical package for the social science


Chi square test


The second cervical vertebral body



This work was supported in part by grant BSW11C065 from key subjects of military medical scientific research fund of China.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.


  1. 1.
    Yin Q, Ai F, Zhang K et al (2005) Irreducible anterior atlantoaxial dislocation: one-stage treatment with a transoral atlantoaxial reduction plate fixation and fusion. Report of 5 cases and review of the literature. Spine-(Phila Pa 1976) 30:E375–E381CrossRefGoogle Scholar
  2. 2.
    Yin QS, Ai FZ, Zhang K, Mai XH, Xia H, Wu ZH (2010) Transoral atlantoaxial reduction plate internal fixation for the treatment of irreducible atlantoaxial dislocation: a 2- to 4-year follow-up. Orthop Surg 2:149–155CrossRefPubMedGoogle Scholar
  3. 3.
    Suk KS, Kim KT, Lee SH et al (2006) Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop 30:290–294CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Jaber S, Chanques G, Matecki S, Ramonatxo M, Vergne C, Souche B, Perrigault PF, Eledjam JJ (2003) Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test. Intensive Care Med 29:69–74CrossRefPubMedGoogle Scholar
  5. 5.
    Daley BJ, Garcia-Perez F, Ross SE (1996) Reintubation as an outcome predictor in trauma patients. Chest 110:1577–1580CrossRefPubMedGoogle Scholar
  6. 6.
    Kriner EJ, Shafazand S, Colice GL (2005) The endotracheal tube cuff-leak test as a predictor for postextubation stridor. Respir Care 50:1632–1638PubMedGoogle Scholar
  7. 7.
    Sandhu RS, Pasquale MD, Miller K, Wasser TE (2000) Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation. J Am Coll Surg 190:682–687CrossRefPubMedGoogle Scholar
  8. 8.
    Andrew SA, Kanwaldeep SS (2007) Airway changes after anterior cervical discectomy and fusion. J Spinal Disord Tech 20:577–581CrossRefPubMedGoogle Scholar
  9. 9.
    Mark AP, Jessica PA, Alan HD et al (2013) Airway compromise due to laryngopharyngeal edema after anterior cervical spine surgery. J Clin Anesth 25:66–72CrossRefGoogle Scholar
  10. 10.
    Manninen PE, Jose GB, Lukitto K et al (2007) Management of the airway in patients undergoing cervical spine surgery. J Neurosurg Anesthesiol 19:190–194CrossRefPubMedGoogle Scholar
  11. 11.
    Ai F, Yin Q, Xu DC, Xia H, Wu Z, Mai XH (2011) Transoral atlantoaxial reduction plate internal fixation with transoral transpedicular or articular mass screw of c2 for the treatment of irreducible atlantoaxial dislocation: two case reports. Spine- (Phila Pa 1976) 36:E556–E562CrossRefGoogle Scholar
  12. 12.
    Benjamin B, Holinger LD (2008) Laryngeal complications of endotracheal intubation. Ann Otol Rhinol Laryngol 117(Suppl 200):1–20Google Scholar
  13. 13.
    Wei JL, Bond J (2011) Management and prevention of endotracheal intubation injury in neonates. Curr Opin Otolaryngol Head Neck Surg 19:474–477CrossRefPubMedGoogle Scholar
  14. 14.
    Colice GL, Stukel TA, Dain B (1989) Laryngeal complications of prolonged intubation. Chest 96:877–884CrossRefPubMedGoogle Scholar
  15. 15.
    Daniel De Backer (2005) The cuff-leak test: what are we measuring? Crit Care 9:31–33CrossRefPubMedGoogle Scholar
  16. 16.
    De Bast Y, De Backer D, Moraine JJ, Lemaire M, Vandenborght C, Vincent JL (2002) The cuff leak test to predict failure of tracheal extubation for laryngeal edema. Intensive Care Med 28:1267–1272CrossRefPubMedGoogle Scholar
  17. 17.
    Wittekamp BHJ, van Mook W, Tjan DHT et al (2009) Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care 13:233CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Jaber S, Chanques G, Matecki S et al (2003) Post-extubation stridor in intensive care unit patients. Intensive Care Med 29:69–74CrossRefPubMedGoogle Scholar
  19. 19.
    Ding LW, Wang HC, Wu HD, Chang CJ, Yang PC (2006) Laryngeal ultrasound: a useful method in predicting post-extubation stridor, A pilot study. Eur Respir J 27:384–389CrossRefPubMedGoogle Scholar
  20. 20.
    Efferen LS, Elsakr A (1998) Post-extubation stridor: risk factors and outcome. J Assoc Acad Minor Phys 9:65–68PubMedGoogle Scholar
  21. 21.
    Epstein SK, Ciubotaru RL (1998) Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 158:489–493CrossRefPubMedGoogle Scholar
  22. 22.
    Cheng KC, Hou CC, Huang HC, Lin SC, Zhang H (2006) Intravenous injection of methylprednisolone reduces the incidence of pos-textubation stridor in intensive care unit patients. Crit Care Med 34:1345–1350CrossRefPubMedGoogle Scholar
  23. 23.
    Ho LI, Harn HJ, Lien TC, Hu PY, Wang JH (1996) Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone. Intensive Care Med 22:933–936CrossRefPubMedGoogle Scholar
  24. 24.
    Lee CH, Peng MJ, Wu CL (2007) Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study. Crit Care 11:R72CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Oshodi A, Dysart K, Cook A, Rodriguez E, Zhu Y, Shaffer TH, Miller TL (2011) Airway injury resulting from repeated endotracheal intubation: possible prevention strategies. Pediatr Crit Care Med 12:e34–e39CrossRefPubMedGoogle Scholar
  26. 26.
    Santos PM, Afrassiabi A, Weymuller EA Jr (1994) Risk factors associated with prolonged intubation and laryngeal injury. Otolaryngol Head Neck Surg 111:453–459PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Jian-qiang Dai
    • 1
    • 2
  • Wei-Feng Tu
    • 3
  • Qing-shui Yin
    • 1
    • 2
  • Hong Xia
    • 2
  • Guo-dong Zheng
    • 2
  • Liang-da Zhang
    • 2
  • Xian-hua Huang
    • 2
  1. 1.Southern Medical UniversityGuangzhouChina
  2. 2.Orthopedic Intensive Care UnitGuangzhou General Hospital of Guangzhou Military CommandGuangzhouChina
  3. 3.Department of AnesthesiologyGuangzhou General Hospital of Guangzhou Military CommandGuangzhouChina

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