{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T21:35:30Z","timestamp":1769981730995,"version":"3.49.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T00:00:00Z","timestamp":1742860800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100018736","name":"Kaken Pharmaceutical","doi-asserted-by":"publisher","award":["22K09017"],"award-info":[{"award-number":["22K09017"]}],"id":[{"id":"10.13039\/100018736","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Anesth"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Cuff-leak volume (CLV) tests are recommended to avoid extubation failure. We developed a novel cuff-leak pressure (CLP) test that quantitatively assesses upper airway resistance outside the tracheal tube. We hypothesized that CLP (airway pressure during apnea with the cuff deflated under a 6\u00a0l\/minute oxygen flow) would increase after surgery (primary outcome) and evaluated the accuracy and reproducibility of CLP measurements by measuring the CLV (difference in expiratory tidal volume before and after deflation of a tracheal tube cuff).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>CLV and CLP were measured before and after abdominal surgery (<jats:italic>n<\/jats:italic>\u2009=\u200925; abdominal group) and cervical spine surgery (<jats:italic>n<\/jats:italic>\u2009=\u200925; spine group) under general anesthesia and complete neuromuscular blockade.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In both groups, the CLP was significantly higher after surgery (median [25%, 75% interquartile ranges]) (abdominal group: 4.0 [1.0, 8.4] cmH<jats:sub>2<\/jats:sub>O to 9.0 [3.4, 13.7] cmH<jats:sub>2<\/jats:sub>O, <jats:italic>P<\/jats:italic>\u2009=\u20090.007; spine group: 8.0 [3.0, 10.9] cmH<jats:sub>2<\/jats:sub>O to 11.0 [7.5, 13.5] cmH<jats:sub>2<\/jats:sub>O, <jats:italic>P<\/jats:italic>\u2009=\u20090.038). The cutoff values for 100% negative and positive predictive values for a positive CLV test (CLV\u2009&lt;\u2009110\u00a0ml or 25% of the tidal volume with the cuff inflated) were 12.0 and 17.3 cmH<jats:sub>2<\/jats:sub>O, respectively, with an AUC of 0.957 (95%CI 0.27\u20131.20). The CLP and CLV measurements were highly reproducible, as the Kendall\u2019s coefficients of concordance were 0.898 (1st and 3rd) and 0.971 (6 consecutive breaths), respectively, although the CLV progressively increased by 29.0 [1.8, 58.8] ml for the 6 consecutive breaths (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Both the CLP and CLV measurements were accurate and highly reproducible to assess postoperative increase of the upper airway resistance before extubation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00540-025-03487-w","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T13:44:48Z","timestamp":1743169488000},"page":"445-455","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Increased cuff-leak pressure after abdominal and spine surgeries: a simple and novel cuff-leak test for tracheal extubation"],"prefix":"10.1007","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2817-7572","authenticated-orcid":false,"given":"Takayuki","family":"Yamada","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katsuhiko","family":"Ishibashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichi","family":"Sakaguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sadatoshi","family":"Kawakami","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natsuko","family":"Nozaki-Taguchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasunori","family":"Sato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiroh","family":"Isono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,25]]},"reference":[{"key":"3487_CR1","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1093\/bja\/aer058","volume":"106","author":"TM Cook","year":"2011","unstructured":"Cook TM, Woodall N, Frerk C, Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anesthetists and the Difficult Airway Society. Part 1: anesthesia. Br J Anaesth. 2011;106:617\u201331.","journal-title":"Br J Anaesth."},{"key":"3487_CR2","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1046\/j.1365-2044.1998.00397.x","volume":"53","author":"K Koga","year":"1998","unstructured":"Koga K, Asai T, Vaughan RS, Latto IP. Respiratory complications associated with tracheal extubation. Timing of tracheal extubation and use of the laryngeal mask during emergence from anesthesia. Anaesthesia. 1998;53:540\u20134.","journal-title":"Anaesthesia."},{"key":"3487_CR3","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1093\/bja\/80.6.767","volume":"80","author":"T Asai","year":"1998","unstructured":"Asai T, Koga K, Vaughan RS. Respiratory complications associated with tracheal intubation and extubation. Br J Anaesth. 1998;80:767\u201375.","journal-title":"Br J Anaesth"},{"key":"3487_CR4","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1213\/ANE.0b013e31827ab572","volume":"116","author":"LF Cavallone","year":"2013","unstructured":"Cavallone LF, Vannucci A. Review article: Extubation of the difficult airway and extubation failure. Anesth Analg. 2013;116:368\u201383.","journal-title":"Anesth Analg"},{"key":"3487_CR5","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1111\/j.1365-2044.2012.07075.x","volume":"67","author":"M Popat","year":"2012","unstructured":"Difficult Airway Society Extubation Guidelines Group, Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012;67:318\u201340.","journal-title":"Anaesthesia."},{"key":"3487_CR6","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1097\/01.CCM.0000198105.65413.85","volume":"34","author":"YH Chung","year":"2006","unstructured":"Chung YH, Chao TY, Chiu CT, Lin MC. The cuff-leak test is a simple tool to verify severe laryngeal edema in patients undergoing long-term mechanical ventilation. Crit Care Med. 2006;34:409\u201314.","journal-title":"Crit Care Med"},{"key":"3487_CR7","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1007\/s00134-010-1847-z","volume":"36","author":"JM Tadi\u00e9","year":"2010","unstructured":"Tadi\u00e9 JM, Behm E, Lecuyer L, Benhmamed R, Hans S, Brasnu D, Diehl JL, Fagon JY, Gu\u00e9rot E. Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study. Intens Care Med. 2010;36:991\u20138.","journal-title":"Intens Care Med"},{"key":"3487_CR8","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1177\/0003489418790348","volume":"127","author":"B Benjamin","year":"2018","unstructured":"Benjamin B. Prolonged intubation injuries of the larynx: endoscopic diagnosis, classification, and treatment. Ann Otol Rhinol Laryngol. 2018;127:492\u2013507.","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"3487_CR9","doi-asserted-by":"publisher","first-page":"355","DOI":"10.4103\/roaic.roaic_76_18","volume":"6","author":"AM Hasan","year":"2019","unstructured":"Hasan AM, Ahmed FI. Predictive value of cuff leak test, laryngeal ultrasound, and fiberoptic laryngoscopy for postextubation stridor after prolonger intubation. Res Opin Anesthes Intens Care. 2019;6:355\u201361.","journal-title":"Res Opin Anesthes Intens Care"},{"key":"3487_CR10","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1183\/09031936.06.00029605","volume":"27","author":"LW Ding","year":"2006","unstructured":"Ding LW, Wang HC, Wu HD, Chang CJ, Yang PC. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study. Eur Respir J. 2006;27:384\u20139.","journal-title":"Eur Respir J"},{"key":"3487_CR11","doi-asserted-by":"publisher","first-page":"238","DOI":"10.5152\/TJAR.2020.176","volume":"49","author":"T Bhargava","year":"2021","unstructured":"Bhargava T, Kumar A, Bharti A, Khuba S. Comparison of laryngeal ultrasound and cuff leak test to predict post-extubation stridor in total thyroidectomy. Turk J Anesthesiol Reanim. 2021;49:238\u201343.","journal-title":"Turk J Anesthesiol Reanim"},{"key":"3487_CR12","doi-asserted-by":"crossref","unstructured":"Girard TD, Alhazzani W, Kress JP, Ouellette DR, Schmidt GA, Truwit JD, Burns SM, Epstein SK, Esteban A, Fan E, Ferrer M, Fraser GL, Gong MN, Hough CL, Mehta S, Nanchal R, Patel S, Pawlik AJ, Schweickert WD, Sessler CN, Str\u00f8m T, Wilson KC, Morris PE; ATS\/CHEST Ad Hoc Committee on Liberation from Mechanical Ventilation in Adults. An Official American Thoracic Society\/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med. 2017;195:120\u201333.","DOI":"10.1164\/rccm.201610-2075ST"},{"key":"3487_CR13","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1186\/s13054-020-03358-8","volume":"24","author":"A Kuriyama","year":"2020","unstructured":"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;24:640.","journal-title":"Crit Care"},{"key":"3487_CR14","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1378\/chest.116.4.1029","volume":"116","author":"M Engoren","year":"1999","unstructured":"Engoren M. Evaluation of the cuff-leak test in a cardiac surgery population. Chest. 1999;116:1029\u201331.","journal-title":"Chest"},{"key":"3487_CR15","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1007\/s00586-016-4487-3","volume":"26","author":"JQ Dai","year":"2017","unstructured":"Dai JQ, Tu WF, Yin QS, Xia H, Zheng GD, Zhang LD, Huang XH. Cuff-leak test combined with interventional bronchoscopy benefits early extubation for patients who received tarp surgery. Eur Spine J. 2017;26:840\u20136.","journal-title":"Eur Spine J"},{"key":"3487_CR16","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1055\/s-0041-1735321","volume":"12","author":"C Prasad","year":"2021","unstructured":"Prasad C, Radhakrishna N, Pandia MP, Khandelwal A, Singh GP, Bithal PK. The effect of goal-directed fluid therapy versus standard fluid therapy on the cuff leak gradient in patients undergoing complex spine surgery in prone position. J Neurosci Rural Pract. 2021;12:745\u201350.","journal-title":"J Neurosci Rural Pract"},{"key":"3487_CR17","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1007\/s13193-022-01605-8","volume":"13","author":"JS Bajaj","year":"2022","unstructured":"Bajaj JS, Sharma S, Mehta N, Shah A, Nimje G, Gorade M, Deshpande G. Frequency of positive cuff leak test before extubation in robotic surgeries done in steep trendelenburg position. Indian J Surg Oncol. 2022;13:896\u2013901.","journal-title":"Indian J Surg Oncol"},{"key":"3487_CR18","first-page":"873","volume":"38","author":"T Ishikawa","year":"2014","unstructured":"Ishikawa T. Evaluation of the upper airway function at tracheal extubation. J Clin Anesth (Jpn). 2014;38:873\u201380.","journal-title":"J Clin Anesth (Jpn)."},{"key":"3487_CR19","first-page":"9","volume":"8","author":"H Azaki","year":"2021","unstructured":"Azaki H, Shinozuka K, Yamagata K. Effectiveness of the cuff-leak test for assessing changes of resistance of the upper respiratory tract. J Oral Sleep Med. 2021;8:9\u201314.","journal-title":"J Oral Sleep Med"},{"key":"3487_CR20","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.1378\/chest.110.4.1035","volume":"110","author":"RL Miller","year":"1996","unstructured":"Miller RL, Cole RP. Association between reduced cuff leak volume and postextubation stridor. Chest. 1996;110:1035\u201340.","journal-title":"Chest"},{"key":"3487_CR21","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/s00134-002-1563-4","volume":"29","author":"S Jaber","year":"2003","unstructured":"Jaber S, Chanques G, Matecki S, Ramonatxo M, Vergne C, Souche B, Perrigault PF, Eledjam JJ. Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test. Intens Care Med. 2003;29:69\u201374.","journal-title":"Intens Care Med."},{"key":"3487_CR22","doi-asserted-by":"publisher","first-page":"170","DOI":"10.4103\/0972-5229.152763","volume":"19","author":"PM Venkategowda","year":"2015","unstructured":"Venkategowda PM, Mahendrakar K, Rao SM, Mutkule DP, Shirodkar CG, Yogesh H. Laryngeal air column width ratio in predicting post extubation stridor. Indian J Crit Care Med. 2015;19:170\u20133.","journal-title":"Indian J Crit Care Med"},{"key":"3487_CR23","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.1056\/NEJMra1811697","volume":"381","author":"A Eskander","year":"2019","unstructured":"Eskander A, de Almeida JR, Irish JC. Acute upper airway obstruction. N Engl J Med. 2019;381:1940\u20139.","journal-title":"N Engl J Med"},{"key":"3487_CR24","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1186\/s13054-015-1018-2","volume":"19","author":"WA Pluijms","year":"2015","unstructured":"Pluijms WA, van Mook WN, Wittekamp BH, Bergmans DC. Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review. Crit Care. 2015;19:295.","journal-title":"Crit Care"},{"key":"3487_CR25","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1097\/ANA.0000000000000028","volume":"26","author":"ZH Anastasian","year":"2014","unstructured":"Anastasian ZH, Gaudet JG, Levitt LC, Mergeche JL, Heyer EJ, Berman MF. Factors that correlate with the decision to delay extubation after multilevel prone spine surgery. J Neurosurg Anesthesiol. 2014;26:167\u201371.","journal-title":"J Neurosurg Anesthesiol"},{"key":"3487_CR26","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1097\/00000542-199208000-00004","volume":"77","author":"JY Darmon","year":"1992","unstructured":"Darmon JY, Rauss A, Dreyfuss D, Bleichner G, Elkharrat D, Schlemmer B, Tenaillon A, Brun-Buisson C, Huet Y. Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. A placebo-controlled, double-blind, multicenter study. Anesthesiology. 1992;77:245\u201351.","journal-title":"Anesthesiology."},{"key":"3487_CR27","doi-asserted-by":"crossref","unstructured":"Isono S. Instability of upper airway during anesthesia and sedation: How is upper airway instable during anesthesia and sedation? Structure-Function Relationships in Various Respiratory Systems - Connecting to the Next Generation Kazuhiro Yamaguchi (Editor) Springer. 2020:67\u201391.","DOI":"10.1007\/978-981-15-5596-1_5"},{"key":"3487_CR28","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1471-2253-14-2","volume":"14","author":"I Bergmann","year":"2014","unstructured":"Bergmann I, Crozier TA, Roessler M, Schotola H, Mansur A, B\u00fcttner B, Hinz JM, Bauer M. The effect of changing the sequence of cuff inflation and device fixation with the LMA-Supreme\u00ae on device position, ventilatory complications, and airway morbidity: a clinical and fiberscopic study. BMC Anesthesiol. 2014;14:2.","journal-title":"BMC Anesthesiol"}],"container-title":["Journal of Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00540-025-03487-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00540-025-03487-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00540-025-03487-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,6]],"date-time":"2025-09-06T09:05:01Z","timestamp":1757149501000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00540-025-03487-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,25]]},"references-count":28,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["3487"],"URL":"https:\/\/doi.org\/10.1007\/s00540-025-03487-w","relation":{},"ISSN":["0913-8668","1438-8359"],"issn-type":[{"value":"0913-8668","type":"print"},{"value":"1438-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,25]]},"assertion":[{"value":"7 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors report no conflicts of interest in this work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}