RT Journal Article
SR Electronic
T1 Safety of Positive Pressure Extubation Technique
JF Respiratory Care
FD American Association for Respiratory Care
SP 899
OP 907
DO 10.4187/respcare.06541
VO 64
IS 8
A1 Mauro F Andreu
A1 María E Dotta
A1 Marco G Bezzi
A1 Silvina Borello
A1 Gimena P Cardoso
A1 Paula C Dib
A1 Silvina L García Schustereder
A1 Alejandra M Galloli
A1 Daniela R Castro
A1 Victoria L Di Giorgio
A1 Federico J Villalba
A1 Matías N Bertozzi
A1 Juan M Carballo
A1 María C Martín
A1 Carla C Brovia
A1 María C Pita
A1 María P Pedace
A1 María F De Benedetto
A1 Julieta Delli Carpini
A1 Patricio Aguirre
A1 Gisela Montero
YR 2019
UL http://rc.rcjournal.com/content/64/8/899.abstract
AB BACKGROUND: Laboratory studies suggest applying positive pressure without endotracheal suction during cuff deflation and extubation. Although some studies reported better physiological outcomes (e.g. arterial blood gases) with this technique, the safety of positive pressure extubation technique has not been well studied. The aim of this study was to determine the safety of the positive-pressure extubation technique compared with the traditional extubation technique in terms of incidence of complications.METHODS: Adult subjects who were critically ill and on invasive mechanical ventilation who met extubation criteria were included. The subjects were randomly assigned to positive-pressure extubation (n = 120) or to traditional extubation (n = 120). Sequential tests for noninferiority and, when appropriate, for superiority were performed. Positive pressure was considered noninferior if the upper limit of the CI for the absolute risk difference did not exceed a threshold of 15% in favor of the traditional group, both in per protocol and intention-to-treat analyses. A P value of <.05 was considered significant.RESULTS: A total of 236 subjects were included in the primary analysis (per protocol) (119 in the positive-pressure group and 117 in the traditional group). The incidence of overall major and minor complications, pneumonia, extubation failure, and reintubation was lower in the positive-pressure group than in the traditional group, with statistical significance for noninferiority both in the per protocol (P < .001) and intention-to-treat (P < .001) analyses. The lower incidence of major complications found in the positive-pressure group reached statistical significance for the superiority comparison, both in per protocol (P = .03) and intention-to-treat (P = .049) analyses. No statistically significant differences were found in the superiority comparison for overall complications, minor complications, pneumonia, extubation failure, and reintubation.CONCLUSIONS: Positive pressure was safe and noninferior to traditional extubation methods. Furthermore, positive pressure has shown to be superior in terms of a lower incidence of major complications. (ClinicalTrials.gov registration NCT03174509.)