Survey on the extubation procedure in intensive care units in Buenos Aires, Argentina

Abstract

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.

Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro

“…According to a survey on extubation practices in the United Kingdom, most critical care nurses applied tracheal suctioning during cuff deflation at extubation. A similar clinical practice has been found in Argentina [4,8]. However, the impact of the positive pressure extubation technique on secretion leakage volume has not been well explored for a recommended pressure level.…”

“…The technical aspects of subglottic secretion elimination during extubation have not been well explored [4]. Generally, two techniques developed to minimize pulmonary aspiration from subglottic secretions are used for extubation-positive or negative pressure [3,5,6].…”

Comparison of Postextubation Complications Between Positive-Pressure and Suctioning Techniques: A Systematic Review

“…After the screening process, 18 of the 4,267 identified studies were considered potential candidates for inclusion in the systematic review. 7,10,11,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Five studies were excluded because they were surveys on extubation techniques or airway management. 10,11,[19][20][21] In addition, 6 studies were excluded because they did not compare positive-pressure and suctioning techniques.…”

“…7,10,11,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Five studies were excluded because they were surveys on extubation techniques or airway management. 10,11,[19][20][21] In addition, 6 studies were excluded because they did not compare positive-pressure and suctioning techniques. [22][23][24][25][26][27] A total of 7 studies, 6 RCTs 7,28-32 and 1 non-randomized controlled study, 33 were finally included in the systematic review.…”

“…Questionnaire surveys of ICU staff members in the United Kingdom and Argentina revealed that the suctioning technique was most frequently performed. 10,11 However, some studies reported that the positive-pressure technique is superior to the suctioning technique. 12,13 To the best of our knowledge, there has been no previous systematic review of studies that investigated extubation techniques.…”