Effects of Endotracheal Extubation with Suctioning versus Positive Pressure in Children after General Anaesthesia, A clinical Trial
DOI:
https://doi.org/10.51253/pafmj.v73i6.9515Keywords:
Extubation with suctioning, General anaesthesia in children, Negative pressure extubation, Positive pressure extubationAbstract
Objective: To observe the effects of extubation with suctioning when compared with extubation with positive pressure in
children after general anaesthesia.
Study Design: Randomized Control Trial (ClinicalTrials.gov: NCT05489809).
Place and Duration of Study: Main Operation Theatre (OT), PNS Shifa Hospital, Karachi Pakistan, from Mar to Aug 2022.
Methodology: Patients were randomly divided into two groups of 40 patients each. One group of patients was extubated after general anaesthesia with negative pressure/suctioning applied to the ETT. In contrast, the other group of patients was
extubated by applying positive pressure to the ETT. The need for additional suctioning more than once and supplemental
oxygen, if required, was documented in the first 3 minutes after extubation (primary endpoints). Additionally, hemodynamic
and respiratory parameters were documented at the time of extubation and 3 minutes after (secondary endpoints).
Results: The results showed that 12(30%) patients out of 40 in the Negative Pressure Extubation-Group required additional
suctioning within the first 3 minutes after extubation compared to only 3(7.5%) patients in the Positive Pressure ExtubationGroup. Furthermore, 3(7.5%) patients in the Negative Pressure Extubation-Group required supplemental oxygen 3 minutes after extubation compared to only 1(2.5%) in the Positive Pressure Extubation-Group.
Conclusion: We observed that negative pressure extubation, when compared to positive pressure extubation, increased the
requirement for suctioning and supplemental oxygen in the first 3 minutes after extubation.
Downloads
References
Benham-Hermetz J, Mitchell V. Safe tracheal extubation after
general anaesthesia. BJA Educ 2021; 21(12): 446-454.
https://doi.org/10.1016/j.bjae.2021.07.003.
Auroy Y, Benhamou D, Péquignot F, Bovet M, Jougla E, Lienhart
A, et al. Mortality related to anaesthesia in France: analysis of
deaths related to airway complications. Anaesthesia 2009; 64(4):
-370. https://doi.org/10.1111/j.1365-2044.2008.05792.x.
Cook TM, Scott S, Mihai R. Litigation related to airway and
respiratory complications of anaesthesia: an analysis of claims
against the NHS in England 1995–2007. Anaesthesia 2010; 65(6):
-563. https://doi.org/10.1111/j.1365-2044.2010.06331.x.
Batuwitage B, Charters P. Postoperative management of the
difficult airway. BJA Educ 2017; 17(7): 235–241.
https://doi.org/10.1093/bjaed/mkw077.
Wong TH, Weber G, Abramowicz AE. Smooth extubation and
smooth emergence techniques: a narrative review. Anesthesiol
Res Pract 2021; 2021: 8883257.
https://doi.org/10.1155%2F2021%2F8883257.
Andreu MF, Dotta ME, Bezzi MG, Borello S, Cardoso GP, Dib
PC, et al. Safety of positive pressure extubation technique. Respir
Care 2019; 64(8): 899-907.
Asenjo JF. Safer intubation and extubation of patients with
COVID-19. Can J Anesth 2020; 67(9): 1276-1278.
https://doi.org/10.1007/s12630-020-01666-9.
Hodd J, Doyle A, Carter J, Albarran J, Young P. Increasing
positive end expiratory pressure at extubation reduces subglottic
secretion aspiration in a bench‐top model. Nurs Crit Care 2010;
(5): 257-261. https://doi.org/10.1111/j.1478-5153.2010.00422.x.
L’Hermite J, Wira O, Castelli C, de La Coussaye JE, Ripart J,
Cuvillon P, et al. Tracheal extubation with suction vs. positive
pressure during emergence from general anaesthesia in adults: a
randomised controlled trial. Anaesth Crit Care Pain Med 2018;
(2): 147-153. https://doi.org/10.1016/j.accpm.2017.07.005.
10. Andreu MF, Salvati IG, Donnianni MC, Ibañez B, Cotignola
M, Bezzi M, et al. Effect of applying positive pressure with or
without endotracheal suctioning during extubation: a laboratory
study. Respirat Care 2014; 59(12): 1905-1911.
https://doi.org/10.4187/respcare.03121.
Guglielminotti J, Constant I, Murat I. Evaluation of routine
tracheal extubation in children: inflating or suctioning
technique?. Bri J Anaesth 1998; 81(5): 692-695.
https://doi.org/10.1093/bja/81.5.692.
Kleinsasser AT, Pircher I, Truebsbach S, Knotzer H, Loeckinger
A, Treml B, et al. Pulmonary function after emergence on 100%
oxygen in patients with chronic obstructive pulmonary disease: a
randomized, controlled trial. Anesthesiology 2014; 120(1): 1146-
https://doi.org/10.1097/aln.0000000000000161.
Mehta S. The risk of aspiration in presence of cuffed
endotracheal tubes. Brit J Anaesth 1972; 44(6): 601-605.
https://doi.org/10.1093/bja/44.6.601.
Farhadi R, Nakhshab M, Hojjati A, Khademloo M. Positive
versus negative pressure during removal of endotracheal-tube
on prevention of post-extubation atelectasis in ventilated
neonates: A randomized controlled trial. Ann Med Surg 2022; 76:
https://doi.org/10.1016%2Fj.amsu.2022.103573.
Andreu M, Bertozzi M, Bezzi M, Borello S, Castro D, Di Giorgio
V, et al. Comparison of Two Extubation Techniques in Critically
Ill Adult Subjects: The ExtubAR Randomized Clinical Trial.
Respirat Care 2022; 67(1): 76-86.
https://doi.org/10.4187/respcare.09276.
Fell T, Cheney FW. Prevention of hypoxia during endotracheal
suction. Ann Surg 1971; 174(1): 24.
https://doi.org/10.1097%2F00000658-197107010-00004.
Jamil AK. Laryngotracheal toilet before extubation. Anaesthesia
; 29(5): 630-631.
https://doi.org/10.1111/j.1365-2044.1974.tb00740.x.
Gerber D, Guensch DP, Theiler L, Erdoes G. When less is more:
why extubation with less than routine 100% oxygen may be a
reasonable strategy. Anesth Analgesia 2019; 129(5): 1433-1435.
https://doi.org/10.1213/ane.0000000000004374.
Young CC, Harris EM, Vacchiano C, Bodnar S, Bukowy B, Elliott
RR, et al. Lung-protective ventilation for the surgical patient:
international expert panel-based consensus recommendations.
Brit J Anaesth 2019; 123(6): 898-913.
Downloads
Published
Issue
Section
How to Cite
