Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro
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 extuba...
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| Format: | Article |
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MDPI AG
2022-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/2/307 |
| _version_ | 1797493019947040768 |
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| author | Tzu-Pei Wang Hsin-Hsien Li Hui-Ling Lin |
| author_facet | Tzu-Pei Wang Hsin-Hsien Li Hui-Ling Lin |
| author_sort | Tzu-Pei Wang |
| collection | DOAJ |
| description | 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 H<sub>2</sub>O. 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 H<sub>2</sub>O 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. |
| first_indexed | 2024-03-10T01:13:59Z |
| format | Article |
| id | doaj.art-4132cc46a8bc41a2adb0bb7867956fbf |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T01:13:59Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-4132cc46a8bc41a2adb0bb7867956fbf2023-11-23T14:11:47ZengMDPI AGJournal of Clinical Medicine2077-03832022-01-0111230710.3390/jcm11020307Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In VitroTzu-Pei Wang0Hsin-Hsien Li1Hui-Ling Lin2Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 11217, TaiwanDepartment of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, TaiwanDepartment of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, TaiwanAccumulated 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 H<sub>2</sub>O. 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 H<sub>2</sub>O 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.https://www.mdpi.com/2077-0383/11/2/307extubationcontinuous positive airway pressuresuctionsubglottic secretionviscosity |
| spellingShingle | Tzu-Pei Wang Hsin-Hsien Li Hui-Ling Lin Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro Journal of Clinical Medicine extubation continuous positive airway pressure suction subglottic secretion viscosity |
| title | Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro |
| title_full | Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro |
| title_fullStr | Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro |
| title_full_unstemmed | Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro |
| title_short | Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro |
| title_sort | positive airway pressure at extubation minimizes subglottic secretion leak in vitro |
| topic | extubation continuous positive airway pressure suction subglottic secretion viscosity |
| url | https://www.mdpi.com/2077-0383/11/2/307 |
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