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

Abstract

Objectives: This review aimed to summarize the recent literature on positive-pressure extubation.

Design: A scoping review was conducted under the framework of the Joanna Briggs Institute.

Data sources: Web of Science, PubMed, Ovid, Cumulative Index to Nursing & Allied Health, EBSCO, Cochrane Library, Wan Fang Data, China National Knowledge Infrastructure, and China Biology Medicine databases were searched for studies on adults and children.

Study selection: All articles describing the use of positive-pressure extubation were considered eligible for inclusion. The exclusion criteria were articles not available in English or Chinese, and those without full text available.

Data extraction and synthesis: The database searches identified 8,381 articles, 15 of which could be included in this review, with an aggregated patient number of 1,544. Vital signs, including mean arterial pressure, heart rate, R-R interval, and SpO₂ before and after extubation; blood gas analysis indexes, including pH, oxygen saturation, PaO₂, and PaCO₂ before and after extubation; and incidence of respiratory complications, including bronchospasm, laryngeal edema, aspiration atelectasis, hypoxemia, and hypercapnia, were reported in the included studies.

Results: The majority of these studies reported that the positive-pressure extubation technique can maintain stable vital signs and blood gas analysis indices as well as prevent complications during the peri-extubation period.

Conclusions: The positive-pressure extubation technique has a safety performance similar to that of the traditional negative-pressure extubation technique and may lead to better clinical outcomes, including stable vital signs, arterial blood gas analysis, and a lower incidence of respiratory complications.

Keywords: airway extubation; extubation complications; extubation methods; positive-pressure extubation; positive-pressure respiration; ventilator weaning.