Research ArticleOriginal Research

Comparison of Two Extubation Techniques in Critically Ill Adult Subjects: The ExtubAR Randomized Clinical Trial

Mauro Andreu, Matías Bertozzi, Marco Bezzi, Silvina Borello, Daniela Castro, Victoria Di Giorgio and Mariana Aguirre on behalf of the ExtubAR group
Respiratory Care January 2022, 67 (1) 76-86; DOI: https://doi.org/10.4187/respcare.09276

References

  1. 1.↵
    1. Boles J-M,
    2. Bion J,
    3. Connors A,
    4. Herridge M,
    5. Marsh B,
    6. Melot C,
    7. et al
    . Weaning from mechanical ventilation. Eur Respir J 2007;29(5):1033-1056.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Artime CA,
    2. Hagberg CA
    . Tracheal extubation. Respir Care 2014Jun;59(6):991-1002; discussion 1002–5.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Rassam S,
    2. SandbyThomas M,
    3. Vaughan RS,
    4. Hall JE
    . Airway management before, during, and after extubation: a survey of practice in the United Kingdom and Ireland. Anaesthesia 2005;60(10):995-1001.
    OpenUrlCrossRefPubMedWeb of Science
  4. 4.↵
    1. Popat M,
    2. Mitchell V,
    3. Dravid R,
    4. Patel A,
    5. Swampillai C,
    6. Higgs A
    ; Difficult Airway Society Extubation Guidelines Group. Difficult Airway Society guidelines for the management of tracheal extubation. Anaesthesia 2012;67(3):318-340.
    OpenUrlCrossRefPubMedWeb of Science
  5. 5.↵
    1. Asai T,
    2. Koga K,
    3. Vaughan RS
    . Respiratory complications associated with tracheal intubation and extubation. Br J Anaesth 1998;80(6):767-775.
    OpenUrlCrossRefPubMedWeb of Science
  6. 6.↵
    1. Guglielminotti J,
    2. Constant I,
    3. Murat I
    . Evaluation of routine tracheal extubation in children: inflating or suctioning technique? Br J Anaesth 1998;81(5):692-695.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Epstein SK
    . Extubation failure. an outcome to be avoided. Crit Care 2004;8(5):310-312.
    OpenUrlCrossRefPubMedWeb of Science
  8. 8.↵
    1. Scales K,
    2. Pilsworth J
    . A practical guide to extubation. Nurs Stand 2007;22(2):44-48.
    OpenUrlPubMed
  9. 9.↵
    1. Hodd J,
    2. Doyle A,
    3. Carter J,
    4. Albarran J,
    5. Young P
    . Increasing positive end-expiratory pressure at extubation reduces subglottic secretion aspiration in a benchtop model. Nurs Crit Care 2010;15(5):257-261.
    OpenUrlPubMed
  10. 10.↵
    1. Dave MH,
    2. Frotzler A,
    3. Madjdpour C,
    4. Koepfer N,
    5. Weiss M
    . Massive aspiration past the tracheal tube cuff caused by closed tracheal suction system. J Intensive Care Med 2011;26(5):326-329.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Hodd J,
    2. Doyle A,
    3. Carter J,
    4. Albarran J,
    5. Young P
    . Extubation in intensive care units in the UK: an online survey. Nurs Crit Care 2010;15(6):281-284.
    OpenUrlPubMed
  12. 12.↵
    1. Andreu MF,
    2. Bezzi M,
    3. Pedace P,
    4. Fredes M,
    5. Salvati I,
    6. Leoz A,
    7. et al
    . Survey on the extubation procedure in intensive care units in Buenos Aires. Argentina. Rev Bras Ter Intensiva 2019;31(2):180-185.
    OpenUrl
  13. 13.↵
    1. Andreu MF,
    2. Dotta ME,
    3. Bezzi MG,
    4. Borello S,
    5. Cardoso GP,
    6. Dib PC,
    7. et al
    . Safety of positive-pressure extubation technique. Respir Care 2019;64(8):899-907.
    OpenUrlAbstract/FREE Full Text
  14. 14.↵
    1. Yousefshahi F,
    2. Barkhordari K,
    3. Movafegh A,
    4. Tavakoli V,
    5. Paknejad O,
    6. Bina P,
    7. et al
    . A new method for extubation: comparison between conventional and new methods. J Tehran Univ Hear Cent 2012;7(3):121-127.
    OpenUrl
  15. 15.↵
    1. Moher D,
    2. Hopewell S,
    3. Schulz KF,
    4. Montori V,
    5. Gøtzsche PC,
    6. Devereaux PJ,
    7. et al
    ; Consolidated Standards of Reporting Trials Group. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomized trials. J Clin Epidemiol 2010;63(8):e1–37-37.
    OpenUrl
  16. 16.↵
    1. MacIntyre NR,
    2. Cook DJ,
    3. Ely EW,
    4. Epstein SK,
    5. Fink JB,
    6. Heffner JE,
    7. et al
    . Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians, the American Association for Respiratory Care, and the American College of Critical Care Medicine. Chest 2001;120(6 Suppl):375S-395S.
    OpenUrlCrossRefPubMedWeb of Science
  17. 17.↵
    1. Cabello B,
    2. Thille AW,
    3. Roche-Campo F,
    4. Brochard L,
    5. Gómez FJ,
    6. Mancebo J
    . Physiological comparison of three spontaneous breathing trials in difficult-to-wean patients. Intensive Care Med 2010Jul;36(7):1171-1179.
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Vidotto MC,
    2. Sogame LC,
    3. Gazzotti MR,
    4. Prandini MN,
    5. Jardim R
    . Analysis of risk factors for extubation failure in patients submitted to nonemergency elective intracranial surgery. Respir Care 2012;57(12):2059-2066.
    OpenUrlAbstract/FREE Full Text
  19. 19.↵
    1. Thille AW,
    2. Harrois A,
    3. Schortgen F,
    4. Brun-Buisson C,
    5. Brochard L
    . Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med 2011;39(12):2612-2618.
    OpenUrlPubMedWeb of Science
  20. 20.↵
    1. Thille AW,
    2. Boissier F,
    3. Ben Ghezala H,
    4. Razazi K,
    5. Mekontso-Dessap A,
    6. Brun-Buisson C
    . Risk factors for and prediction by caregivers of extubation failure in ICU patients. Crit Care Med 2015;43(3):613-620.
    OpenUrlPubMed
  21. 21.↵
    1. Fernandez MM,
    2. González-Castro A,
    3. Magret M,
    4. Bouza MT,
    5. Ibañez M,
    6. García C,
    7. et al
    . Reconnection to mechanical ventilation for 1 h after a successful spontaneous breathing trial reduces re-intubation in critically ill patients: a multi-center randomized controlled trial. Intensive Care Med 2017;43(11):1660-1667.
    OpenUrlPubMed
  22. 22.↵
    1. Bezzi M
    . Positive-pressure extubation technique. AJRPT 2019;2(1):53-56.
    OpenUrl
  23. 23.↵
    1. Andreu MF,
    2. Salvati IG,
    3. Donnianni MC,
    4. Ibañez B,
    5. Cotignola M,
    6. Bezzi M
    . Effect of applying positive pressure with or without endotracheal suctioning during extubation: a laboratory study. Respir Care 2014;59(12):1905-1911.
    OpenUrlAbstract/FREE Full Text
  24. 24.↵
    1. Richardson PB,
    2. Krishnan S,
    3. Janakiraman C,
    4. Nicolson D,
    5. Wilkes AR,
    6. Hodzovic I
    . Extubation after anesthesia: a randomized comparison of three extubation strategies. Eur J Anaesthesiol 2012;29:241.
    OpenUrl
  25. 25.↵
    1. Epstein S
    . Endotracheal extubation. Respir Care Clin N Am 2000;6(2):321-360.
    OpenUrlCrossRefPubMed
  26. 26.↵
    American Association for Respiratory Care. AARC clinical practice guidelines. Removal of the endotracheal tube—2007 revision and update. Respir Care 2007;52(1):81-93. Available at: http://rc.rcjournal.com/content/respcare/52/1/81.full.pdf.
    OpenUrlFREE Full Text
  27. 27.↵
    1. Minogue SC,
    2. Ralph J,
    3. Lampa MJ
    . Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg 2004;99(4):1253-1257.
    OpenUrlCrossRefPubMedWeb of Science
  28. 28.↵
    1. Epstein SK,
    2. Ciubotaru RL,
    3. Wong JB
    . Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112(1):186-192.
    OpenUrlCrossRefPubMedWeb of Science
  29. 29.↵
    1. Epstein S
    . Decision to extubate. Intensive Care Med 2002;28(5):535-546.
    OpenUrlCrossRefPubMedWeb of Science
  30. 30.↵
    1. Blot SI,
    2. Poelaert J,
    3. Kollef M
    . How to avoid microaspiration? A key element for the prevention of ventilator-associated pneumonia in intubated ICU patients. BMC Infect Dis 201428;14(1):119.
    OpenUrl
  31. 31.
    1. Craven DE,
    2. Chroneou A,
    3. Zias N,
    4. Hjalmarson KI
    . Ventilator-associated tracheobronchitis. Chest 2009;135(2):521-528.
    OpenUrlCrossRefPubMed
  32. 32.
    1. Pneumatikos IA,
    2. Dragoumanis CK,
    3. Bouros DE
    . Ventilator-associated pneumonia or endotracheal tube–associated pneumonia?: an approach to the pathogenesis and preventive strategies emphasizing the importance of endotracheal tube. Anesthesiology 2009;110(3):673-680.
    OpenUrlCrossRefPubMedWeb of Science
  33. 33.↵
    1. Estes RJ,
    2. Meduri GU
    . The pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation. Intensive Care Med 1995;21(4):365-383.
    OpenUrlCrossRefPubMedWeb of Science
  34. 34.↵
    American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and health care–associated pneumonia. Am J Respir Crit Care Med 2005; 15;171(4):388-416.
    OpenUrlCrossRefPubMedWeb of Science
  35. 35.↵
    1. L’Hermite J,
    2. Wira O,
    3. Castelli C,
    4. de La Coussaye JE,
    5. Ripart J,
    6. Cuvillon P
    . Tracheal extubation with suction vs positive-pressure during emergence from general anesthesia in adults: a randomized controlled trial. Anaesth Crit Care Pain Med 2018;37(2):147-153.
    OpenUrl
  36. 36.↵
    1. Miller KA,
    2. Harkin CP,
    3. Bailey PL
    . Postoperative tracheal extubation. Anesth Analg 1995;80(1):149-172.
    OpenUrlCrossRefPubMedWeb of Science
  37. 37.↵
    1. Andreu MF,
    2. Bezzi MG,
    3. Dotta ME
    . Incidence of immediate postextubation complications in critically Ill adult patients. Hear Lung 2020 Nov;49(6):774-778.
    OpenUrl
  38. 38.↵
    1. Thille AW,
    2. Cortés-Puch I,
    3. Esteban A
    . Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care 2013;19(1):57-64.
    OpenUrlPubMed
  39. 39.
    1. Esteban A,
    2. Alía I,
    3. Gordo F,
    4. Fernández R,
    5. Solsona JF,
    6. Vallverdu I,
    7. et al
    . Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. Am J Respir Crit Care Med 1997;156(2):459-465.
    OpenUrlCrossRefPubMedWeb of Science
  40. 40.
    1. Esteban A,
    2. Alía I,
    3. Tobin MJ,
    4. Gil A,
    5. Gordo F,
    6. Vallverdú I,
    7. et al
    . Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Am J Respir Crit Care Med 1999;159(2):512-518.
    OpenUrlCrossRefPubMedWeb of Science
  41. 41.
    1. Frutos-Vivar F,
    2. Ferguson ND,
    3. Esteban A,
    4. Epstein SK,
    5. Arabi Y,
    6. Apezteguía C,
    7. et al
    . Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 2006;130(6):1664-1671.
    OpenUrlCrossRefPubMedWeb of Science
  42. 42.
    1. Frutos-Vivar F,
    2. Esteban A,
    3. Apezteguia C,
    4. González M,
    5. Arabi Y,
    6. Restrepo MI,
    7. et al
    . Outcome of re-intubated patients after scheduled extubation. J Crit Care 2011;26(5):502-509.
    OpenUrlCrossRefPubMed
  43. 43.
    1. Funk GC,
    2. Anders S,
    3. Breyer MK,
    4. Burghuber OC,
    5. Edelmann G,
    6. Heindl W,
    7. et al
    . Incidence and outcome of weaning from mechanical ventilation according to new categories. Eur Respir J 2010;35(1):88-94.
    OpenUrlAbstract/FREE Full Text
  44. 44.↵
    1. Jung B,
    2. Vaschetto R,
    3. Jaber S
    . Ten tips to optimize weaning and extubation success in the critically ill. Intensive Care Med 2020;46(12):2461-2463.
    OpenUrlPubMed
  45. 45.↵
    1. Pluijms WA,
    2. van Mook WNKA,
    3. Wittekamp BHJ,
    4. Bergmans DCJJ
    . Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review. Crit Care 2015;19(1):1-9.
    OpenUrlCrossRefPubMed
  46. 46.↵
    1. Baftiu N,
    2. Krasniqi I,
    3. Haxhirexha K,
    4. Domi R
    . Survey about the extubation practice among anesthesiologists in Kosovo. Open Access Maced J Med Sci 2018;6(2):350-354.
    OpenUrl
  47. 47.↵
    1. Adderley RJ,
    2. Mullins GC
    . When to extubate the croup patient: the “leak” test. Can J Anaesth 1987;34(3 (Pt 1):304-306.
    OpenUrlPubMedWeb of Science
  48. 48.↵
    1. Potgieter PD,
    2. Hammond JM
    . “Cuff” test for safe extubation following laryngeal edema. Crit Care Med 1988;16(8):818.
    OpenUrlPubMed
  49. 49.↵
    1. Gros A,
    2. Holzapfel L,
    3. Marque S,
    4. Perard L,
    5. Demingeon G,
    6. Piralla B,
    7. et al
    . Intra-individual variation of the cuff-leak test as a predictor of postextubation stridor. Respir Care 2012;57(12):2026-2031.
    OpenUrlAbstract/FREE Full Text
  50. 50.↵
    1. Prinianakis G,
    2. Alexopoulou C,
    3. Mamidakis E,
    4. Kondili E,
    5. Georgopoulos D
    . Determinants of the cuff-leak test: a physiological study. Crit Care 2005;9(1):R24-31.
    OpenUrlCrossRefPubMedWeb of Science
  51. 51.↵
    1. De Backer D
    . The cuff-leak test: what are we measuring? Crit Care 2005;9(1):31-33.
    OpenUrlCrossRefPubMedWeb of Science
  52. 52.↵
    1. Kuriyama A,
    2. Jackson JL,
    3. Kamei J
    . Performance of the cuff-leak test in adults in predicting postextubation airway complications: a systematic review and meta-analysis. Crit Care 2020 Nov 7;24(1):640.
    OpenUrl
  53. 53.↵
    1. Jeon K,
    2. Jeong BH,
    3. Ko MG,
    4. Nam J,
    5. Yoo H,
    6. Chung CR,
    7. Suh GY
    . Impact of delirium on weaning from mechanical ventilation in medical patients. Respirology 2016 Feb;21(2):313-320.
    OpenUrl
  54. 54.↵
    1. Vincent J-L,
    2. Shehabi Y,
    3. Walsh TS,
    4. Pandharipande PP,
    5. Ball JA,
    6. Spronk P,
    7. et al
    . Comfort and patient-centered care without excessive sedation: the eCASH concept. Intensive Care Med 2016 Jun;42(6):962-971.
    OpenUrlCrossRefPubMed
  55. 55.↵
    Centers for Disease Control and Prevention. Infection Control in Healthcare Personnel: Infrastructure and Routine Practices for Occupational Infection Prevention and Control Services. Available at: https://www.cdc.gov/infectioncontrol/guidelines/healthcare-personnel/index.html; https://www.cdc.gov/infectioncontrol/pdf/guidelines/infection-control-HCP-H.pdf. Accessed October 30, 2020.
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