Effects of Positive Airway Pressure at Extubation in Patients Undergoing Upper Airway-related Surgery

Objective: The evidence base for extubation is limited, and some recommendations are based on traditional habits and expert opinion. We organized this study to provide an objective interpretation of the discussions regarding cuff deflation in extubation. Our aim was to reveal the results of maintaining positive airway pressure until tracheal extubation and removing the endotracheal tube with the halfdeflated cuff. Methods: This study was approved by the local ethics committee and performed in accordance with the ethical standards of the Declaration of Helsinki. Written informed consent was obtained from the patient. Patients were randomized to one of two groups using a sealed envelope technique. In the control group, patients were extubated using the conventional method. In the study group, the pressure adjustment valve was set to 20-30 cmH2O, and positive pressure was maintained until extubation. After measuring the cuff pressure, the cuff was half-deflated, and the tracheal tube was removed. Results: A total of 68 patients were included. There was no statistically significant difference between the groups in terms of complications except coughing. Conclusion: The most important finding was the lack of a statistically significant difference between the two groups in terms of complications of extubation, except cough. This result is valuable because the main concern is laryngeal injury by a half-deflated cuff. We attributed the low incidence of cough to the excretion of irritants and the pressure gradient across the cuff after positive pressure. While there is a lack of clear data on laryngeal injury with an undeflated cuff, considering its advantages, it is reasonable to introduce this technique into daily practice.