Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro

Tzu Pei Wang, Hsin Hsien Li, Hui Ling Lin*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

1 Scopus citations


Accumulated secretion above the endotracheal tube cuff can be aspirated during extuba-tion after deflation. The possible techniques for minimizing pulmonary aspiration from subglottic secretion during extubation have not been well explored. This study aimed to determine the effect of different extubation techniques on secretion leakage. An endotracheal tube was placed in a tube mimicking an airway. We measured the leak volume of water or artificial sputum of different viscosities with three extubation techniques—negative pressure with suctioning; positive pressure with a resuscitator; and continuous positive airway pressure set at 5, 10, and 20 cm H2 O. Extubation with continuous positive airway pressure resulted in lower secretion leakage than that with negative pressure with suctioning and positive pressure with a resuscitator. Increasing the continuous positive airway pressure level decreased secretion leakage volume during extubation. We further determined a correlation of leak volume with sputum viscosity. Continuous positive airway pressure at 5 cm H2 O produced lower volume secretion leakage than the other two techniques, even with higher secretion viscosity. Based on these results, using continuous positive airway pressure with a previous ventilator continuous positive airway pressure/positive end-expiratory pressure setting for extubation is recommended.

Original languageEnglish
Article number307
JournalJournal of Clinical Medicine
Issue number2
StatePublished - 01 01 2022

Bibliographical note

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • Continuous positive airway pressure
  • Extubation
  • Subglottic secretion
  • Suction
  • Viscosity


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