Document Detail

Effect of Applying Positive Pressure With or Without Endotracheal Suctioning During Extubation: A Laboratory Study.
MedLine Citation:
PMID:  25425709     Owner:  NLM     Status:  Publisher    
BACKGROUND: During invasive mechanical ventilation, secretions accumulate in the subglottic space; consequently, there is a risk of aspiration of these secretions into the airway during cuff deflation and extubation. To minimize this risk, 2 extubation methods are used. The first consists of introducing a suction catheter into the endotracheal tube (ETT) and the trachea. After initiating suctioning, the cuff is deflated and the ETT is removed together with the suction catheter. The second technique involves applying positive pressure to the ETT using a resuscitation bag. Once the manual breath is delivered, the ETT cuff is deflated and the ETT is removed without suction. The aim of this laboratory study is to determine the existence and magnitude of differences in leak volume during cuff deflation and extubation using various combinations of positive pressure with or without endotracheal suctioning.
METHODS: An ETT connected to a ventilator was placed in a model trachea. Colored water was instilled in the space above the cuff. To measure the leak volume, a collection chamber was attached to the distal end of the model. Nine procedures were defined, based on the delivery of different positive pressure levels with or without endotracheal suctioning during extubation. The volume of leakage, in milliliters, was the unit of analysis. Procedures yielding values lower than 1 mL were assessed by the Friedman test, and a P value of less than .05 was considered significant. Post hoc comparisons were performed with a Wilcoxon test, followed by a Bonferroni correction.
RESULTS: The application of CPAP15, pressure support ventilation (PSV)15/10, and PSV20/5 produced 0.4, 0.2, and 0.1 mL of leak volume, respectively. Statistically significant differences were found between CPAP15 and PSV15/10 (P = .003) and between CPAP15 and PSV20/5 (P = .01), but not between PSV15/10 and PSV20/5 (P = .30). The addition of suctioning increased leak volume, with statistically significant differences between CPAP15 and CPAP15 + endotracheal suctioning (P = .001) and between PSV15/10 and PSV15/10 + endotracheal suctioning (P = .001).
CONCLUSIONS: Endotracheal suctioning during cuff deflation and extubation produced greater leakage. Application of CPAP15, PSV15/10, and PSV20/5 resulted in the lowest leak values, with the best results being obtained with the use of PSV15/10 and PSV20/5.
Mauro F Andreu; Iris G Salvati; Mariana C Donnianni; Belén Ibañez; Mariana Cotignola; Marco Bezzi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-11-25
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  1943-3654     ISO Abbreviation:  Respir Care     Publication Date:  2014 Nov 
Date Detail:
Created Date:  2014-11-26     Completed Date:  -     Revised Date:  2014-11-27    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 by Daedalus Enterprises Inc.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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