Extubation after anaesthesia: a randomised comparison of three techniques

The mode of ventilation used during awake extubation has not previously been studied. We conducted a randomised controlled trial comparing spontaneous respiration, intermittent positive pressure ventilation, and pressure support ventilation (each n = 13) for incidence and severity of peri-extubation complications following routine elective surgery. We found the severity of peri-extubation cough was significantly affected by mode of ventilation used at extubation (p = 0.049), with lowest severity grades for those in the pressure support ventilation group. The mean arterial pressure at extubation was lowest in the intermittent positive pressure ventilation group (p = 0.007). Other peri-extubation complications and time to extubation following cessation of anaesthesia were not significantly different across the three groups. We suggest that the use of pressure support ventilation for awake extubation may offer an advantage over spontaneous and intermittent positive pressure ventilation extubation strategies.