Abstract:

Objective To compare the impact of positive pressure extubation and negative pressure extubation on extubation complications in patents with successful spontaneous breathing test. Methods 48 patients with successful spontaneous breathing trial in a first-class level hospital from July 1 ,2019 to December 31 , 2019 were enrolled and were divided into positive pressure ex tu bation group(25 cases) and negative pressure extubation group(23 cases) using a random number table. End Expiratory Lung Impedance changes (delta EELI % )was a primary observation index. Secondary observ ation indexes included breathing rate ,heart rate , mean arterial pressure, blood oxygensaturation changes and upper airw ay complications which included airway hy perresponsiveness (wheezing in the larynx, new wheezing in both lungs) ,severe coughing , and respiratory distress. Results In the positive pressure extubation group , EELI% decreased by (14.84+2.03)% after extubation, and all EELI returmned to the level before extubation within an average of one minute. In the negative pressure extubation group, the EELI% decreased by(3 1.09+4.64)% after extubation,the average time for EELI to return to the level before extubation was 3 minutes ,and the EELI within 30 minutes after extubation in 4 patients was still lower than the level before extubation. The difference between the two groups was statistically significant ( P<0.05). The number of complications occurred within 30 minutes after extubation was compared between the two groups. Shortness of breath occurred in 5 cases vs.15 cases in positive pressure vs. negative pressure group. HR increased by 20%(4 cases vs.11 cases), MAP increased by 20%(2 cases vs.8 cases) ,SpO2 decreased by more than 5%(2 cases vs.8 cases) ,and SpO2 decreased by more than 5%(2 cases vs.8 cases).Upper airway complications included airway hyperresponsiveness(1 vs.6 cases) , severe cough (3 vs.9 cases),and gastric reflux(1 vs.6 cases )and respiratory distress(2 vs.10 cases).The differences of complications were statistically significant between two groups (P<0.05 ). Conclusion Positive pressure extubation can effectively reduce the pulmonary collapse caused by extubation and reduce the incidence of upper airway complications.

Key words:

Airway Extubation;Extubation Methods;Pulmonary Atelectasis, Hypoxemia;Endotracheal Suctioning, Electrical Impedance Tomography