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

Abstract

BACKGROUND: Several studies have investigated postextubation complications of the positivepressure and suctioning techniques; however, these studies yielded inconsistent results. Therefore, in this systematic review, we aimed to assess and compare the risk of complications between these techniques after extubation. METHODS: This study was registered with the International Prospective Register of Systematic Reviews (CRD42021272068). We searched for randomized controlled trials (RCT) or observational studies that compared positive-pressure and suctioning extubation techniques in medical literature databases. Our search was conducted from the databases' inception to July 7, 2022. The included studies were assessed for quality by using a risk of bias tool. RESULTS: Six RCTs and 1 non-randomized controlled study were included in this systematic review (N 5 1,575 subjects), wherein the positive-pressure and suctioning techniques were applied to 762 and 813 subjects, respectively. Three studies were conducted in operating rooms, and 4 studies were conducted in ICUs. Five studies were conducted among adults, and 2 studies were conducted among children or neonates. All the studies except 1 RCT showed that the positive-pressure technique tended to have a lower but not statistically different risk of complications, including desaturation, airway obstruction, pneumonia, aspiration, atelectasis, and reintubation, than the suctioning technique. Three of the 6 RCTs were determined to have a high risk of bias and the 1 non-randomized controlled study was determined to have a serious risk of bias. CONCLUSIONS: The positive-pressure technique tended to have a lower risk of complications than the suctioning technique. Further high-quality studies are warranted.

Effect of lung volume preservation during spontaneous breathing trial on successful extubation among patients receiving mechanical ventilation. Study protocol for a multi-center clinical trial.

“…Two clinical trials by Andreu et al (15,16) demonstrated that using positive pressure resulted in similar clinical outcomes than using continuous suction during extubation. Recently, a systematic review on suction and positive pressure extubation was unable to conclude any recommendation and encouraged more studies to elucidate this question (17).…”