Investigation of the effects of PEEP and pressure support ventilation on respiratory system complications during extubation

Anesthetists encounter various complications during the process of extubation, where the endotracheal tube is removed after surgical procedures, leading to the patient being separated from the mechanical ventilator. Previous studies have demonstrated that pressure support ventilation during extubation reduces postoperative atelectasis. In our study, we aimed to observe the effects of pressure support ventilation and PEEP modeling during extubation on other respiratory system complications. Patients with ASA scores of 1-3 undergoing laparoscopic cholecystectomy were included in the study. The initial mode selected on the mechanical ventilator was PCV mode for the patient group. During emergence (awakening), synchronization was initiated, transitioning to the P-SIMV mode, and the patient's awakening and extubation process were completed in this mode. Patients who regained muscle strength and responded to verbal commands were extubated while awake, and any resulting complications were recorded. In our study, at least one respiratory system complication was observed in 18.59% of the 199 patients included. Different studies in the literature report this rate between 11-48%, and these figures were evaluated similarly to the results of our study. Additionally, no instances of laryngospasm were observed in our study. The incidence of persistent cough and emergence agitation was less frequent compared to other studies in the literature. Major complications such as re-intubation and intensive care unit admission were not observed in any of the patients. Our study is a single-center prospective study, and further randomized controlled studies are needed. Key Words: Extubation, Pressure Support Ventilation, PEEP, Emergence