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.
Objective
To examine the usual practice of airway management during the extubation
procedure through an online survey to professionals working in intensive
care units in the Autonomous City of Buenos Aires and in the Province of
Buenos Aires, Argentina.
Methods
A cross-sectional descriptive study online survey was conducted from February
11 to March 11, 2013. A database was generated, and a voluntary and
anonymous invitation to access the survey was sent by email to 500
participants.
Results
Out of a total of 500 participants, 217 (44%) responded to the survey, of
whom 59.4% were physical therapists. One hundred ninety-five (89.9%)
professionals were working in adult care. Regarding the cuff deflation
procedure and extubation, 203 (93.5%) performe endotracheal suctioning, and
27 (12.5%) use positive pressure. Approximately 53.5% of participants
reported having experienced immediate complications with this procedure in
the last three months. In all, 163 complications were reported, and stridor
was the most prevalent (52.7%).
Conclusion
Most professionals working in intensive care units in the Autonomous City of
Buenos Aires and in the Province of Buenos Aires, Argentina, use
endotracheal suctioning without applying positive pressure during
extubation.
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