Continuous positive airway pressure improves the immediate post-extubation airway patency

Endotracheal tube extubation can cause laryngospasm, aspiration, upper airway obstruction and hypoxia. In addition, the risk of pulmonary complication increases during extubation for the patients with a difficult airway or a cervical spine injury. The aim of this study was to exam the effect of continuous positive airway pressure (CPAP) on the post-extubation airway patency and the recovery from anesthesia at the recovery room.

30 adult patients who were scheduled for spine surgery were randomly allocated into 2 groups depending on the using of CPAP before extubation. Neuromuscular monitoring was performed via accelomyography. Tracheal extubation was performed at a TOF ratio of 70%. The incidence of spontaneous recovery of respiration, without airway manipulation and hypoxia, at the recovery room was measured for each group. The time to get a PAR score of 10 at the recovery room and the discharge time from the recovery room were checked too.

The incidence of spontaneous recovery of respiration without airway manipulation was 67% in the CPAP group, which was significantly greater than that of the control group (13%). Yet there was no difference between the CPAP and control groups for the incidence of hypoxia in the recovery room (13% and 20%, respectively). There were also no differences in the time to get a PAR score of 10 at the recovery room and the discharge time from the recovery room.

CPAP that is applied for tracheal tube extubation improves the immediate post-extubation airway patency, but it does not reduce the recovery room pulmonary complications and the recovery room discharge time.