Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro

Abstract

Accumulated secretion above the endotracheal tube cuff can be aspirated during extubation after deflation. The possible techniques for minimizing pulmonary aspiration from subglottic secretion during extubation have not been well explored. This study aimed to determine the effect of different extubation techniques on secretion leakage. An endotracheal tube was placed in a tube mimicking an airway. We measured the leak volume of water or artificial sputum of different viscosities with three extubation techniques—negative pressure with suctioning; positive pressure with a resuscitator; and continuous positive airway pressure set at 5, 10, and 20 cm H2O. Extubation with continuous positive airway pressure resulted in lower secretion leakage than that with negative pressure with suctioning and positive pressure with a resuscitator. Increasing the continuous positive airway pressure level decreased secretion leakage volume during extubation. We further determined a correlation of leak volume with sputum viscosity. Continuous positive airway pressure at 5 cm H2O produced lower volume secretion leakage than the other two techniques, even with higher secretion viscosity. Based on these results, using continuous positive airway pressure with a previous ventilator continuous positive airway pressure/positive end-expiratory pressure setting for extubation is recommended.

Positive- vs. negative-pressure extubation technique: a scoping review

“…This could be addressed by mechanical ventilation using the pressure support mode at a level of 15/10 cm H 2 O or 20/5 cm H 2 O, resulting in minimal leakage. In another laboratory study (26), three extubation methods were designed to measure the leakage of water or artificial sputum (with different viscosities): negativepressure suction, positive-pressure by a resuscitator, and ventilation following a continuous positive airway pressure mode with the pressure level set at 5, 10, and 20 cm H 2 O. The results showed that continuous positive airway pressure extubation resulted in less secretion leakage than the other methods.…”