TY - JOUR T1 - Comparison of Two Extubation Techniques in Critically Ill Adult Subjects: The ExtubAR Randomized Clinical Trial JF - Respiratory Care DO - 10.4187/respcare.09276 SP - respcare.09276 AU - Mauro Andreu AU - Matías Bertozzi AU - Marco Bezzi AU - Silvina Borello AU - Daniela Castro AU - Victoria Di Giorgio AU - Mariana Aguirre AU - Karina Miralles AU - Diego Noval AU - Sebastián Fredes AU - Eliana Wilhelm AU - Mauricio Zakimchuk AU - Julián Buffarini Cignoli AU - Mariana Bernardini AU - Leticia Rey AU - Valeria Pieroni AU - Pablo D'Annunzio AU - Gustavo Plotnikow AU - Romina Pratto AU - Matías Lompizano AU - María Guaymas AU - Matías Accoce AU - Javier Dorado AU - Gimena Cardoso AU - Patricia Torres AU - Vanesa Pavlotsky AU - Emiliano Navarro AU - Eliana Markman AU - Paula Di Nardo AU - Ivonne Kunzi Steyer AU - Carolina Thomsen AU - Cecilia Palacios AU - Mariela Davies AU - Mercedes Ruffo AU - Victoria León AU - Fernando Tapia Y1 - 2021/11/03 UR - http://rc.rcjournal.com/content/early/2021/11/03/respcare.09276.abstract N2 - BACKGROUND: Two orotracheal extubation techniques are described in the literature: the traditional technique and the positive-pressure technique. Although prior studies reported better clinical outcomes with the positive-pressure extubation technique, its superiority has not been extensively studied yet. This study was to determine whether the positive-pressure orotracheal extubation technique, compared with the traditional orotracheal extubation technique, reduces the incidence of major postextubation complications (up to 60 min) in critically ill adult subjects.METHODS: This was a multi-center randomized clinical trial. Subjects age > 18 y, requiring invasive mechanical ventilation through an endotracheal tube, who met the orotracheal extubation criteria were included and randomized to traditional extubation group (removing the endotracheal tube by applying continuous endotracheal suctioning during the entire procedure) or positive-pressure group (application of pressure support mode at 15/10 cm H2O during cuff deflation and extubation). The primary measure was postextubation major complications, defined as the clinical evidence of at least one of the following: desaturation, upper-airway obstruction, or vomiting.RESULTS: A total of 725 subjects was randomly assigned to the traditional extubation group (n = 358) and positive-pressure group (n = 367). Seventeen subjects were eliminated and not included in the per-protocol analysis. Of 708 subjects, 185 (26.1%) developed at least one major complication. The incidence was 27.8% (96/345) in the traditional group compared with 24.5% (89/363) in the positive-pressure group. No statistically significant differences were observed between the 2 groups (absolute risk 3% [95 CI −3 to 10]; relative risk, 0.88 [95 CI 0.69−1.13], P = .32).CONCLUSIONS: Despite the trend toward the positive-pressure group, no statistically significant differences were observed. Our findings agree with the literature in that positive-pressure extubation is a safe procedure; therefore, both techniques may be used during extubation in critically ill adult patients. ER -