RT Journal Article
SR Electronic
T1 Comparison of Two Extubation Techniques in Critically Ill Adult Subjects: The ExtubAR Randomized Clinical Trial
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.09276
DO 10.4187/respcare.09276
A1 Mauro Andreu
A1 Matías Bertozzi
A1 Marco Bezzi
A1 Silvina Borello
A1 Daniela Castro
A1 Victoria Di Giorgio
A1 Mariana Aguirre
A1 Karina Miralles
A1 Diego Noval
A1 Sebastián Fredes
A1 Eliana Wilhelm
A1 Mauricio Zakimchuk
A1 Julián Buffarini Cignoli
A1 Mariana Bernardini
A1 Leticia Rey
A1 Valeria Pieroni
A1 Pablo D'Annunzio
A1 Gustavo Plotnikow
A1 Romina Pratto
A1 Matías Lompizano
A1 María Guaymas
A1 Matías Accoce
A1 Javier Dorado
A1 Gimena Cardoso
A1 Patricia Torres
A1 Vanesa Pavlotsky
A1 Emiliano Navarro
A1 Eliana Markman
A1 Paula Di Nardo
A1 Ivonne Kunzi Steyer
A1 Carolina Thomsen
A1 Cecilia Palacios
A1 Mariela Davies
A1 Mercedes Ruffo
A1 Victoria León
A1 Fernando Tapia
YR 2021
UL http://rc.rcjournal.com/content/early/2021/11/03/respcare.09276.abstract
AB 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.