{
    "abstract": "The optimal method for removing the endotracheal tube (ETT) during extubation in the intensive care unit (ICU) remains uncertain. Two methods are described for removing the ETT in ICU, namely the 'Traditional technique' with continuous aspiration during cuff deflation and ETT removal; and the 'PEEP' method, which consists in applying positive end-expiratory pressure (PEEP) before and during cuff deflation and ETT removal. Our hypothesis is that applying PEEP during extubation in the ICU would improve clinical outcome.\nThis is a prospective, multicentre, randomised, open-label, controlled, superiority trial, analysed by intention-to-treat, comparing ETT removal with concomitant suction vs application of PEEP before and during ETT removal. In total, 424 patients will be recruited and randomly assigned in a 1:1 ratio to one of two groups, according to the strategy of ETT removal. The primary outcome is the number of days free from any mechanical ventilation within 28 days following extubation. Secondary outcomes include the reintubation rate up to 7\u2009days after ETT removal, the cumulative duration of non-invasive ventilation up to 7\u2009days following extubation, the rate of acute respiratory failure, the rate of acquired pneumonia during the first 7\u2009days following ETT removal, the length of stay in ICU and in hospital and all-cause mortality at 28 days following ETT removal.\nThe study was approved by the Ethics Committee 'CPP Ile de France II'. Patients will be included after providing written informed consent. The results will be submitted for publication in peer-reviewed journals, and in national and international congresses.\nNCT05147636.",
    "authors": [
        {
            "affiliation": "H\u00f4pital Fleyriat, Service de R\u00e9animation Polyvalente, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, Rh\u00f4ne-Alpes, France nsedillot@ch-bourg01.fr.",
            "firstname": "Nicholas",
            "initials": "N",
            "lastname": "Sedillot"
        },
        {
            "affiliation": "H\u00f4pital Fleyriat, Service de R\u00e9animation Polyvalente, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, Rh\u00f4ne-Alpes, France.",
            "firstname": "Hela",
            "initials": "H",
            "lastname": "Kallel"
        },
        {
            "affiliation": "H\u00f4pital Fleyriat, Service de R\u00e9animation Polyvalente, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, Rh\u00f4ne-Alpes, France.",
            "firstname": "Adrien",
            "initials": "A",
            "lastname": "Robine"
        },
        {
            "affiliation": "LabEx LipSTIC, Universite de Bourgogne, Dijon, Bourgogne-Franche-Comt\u00e9, France.\nService de M\u00e9decine Intensive-R\u00e9animation, CHU Dijon, Dijon, Bourgogne-Franche-Comt\u00e9, France.",
            "firstname": "Jose Arturo",
            "initials": "JA",
            "lastname": "Pineda"
        },
        {
            "affiliation": "LabEx LipSTIC, Universite de Bourgogne, Dijon, Bourgogne-Franche-Comt\u00e9, France.\nService de M\u00e9decine Intensive-R\u00e9animation, CHU Dijon, Dijon, Bourgogne-Franche-Comt\u00e9, France.",
            "firstname": "Jean-Pierre",
            "initials": "JP",
            "lastname": "Quenot"
        },
        {
            "affiliation": "R\u00e9animation m\u00e9dico-chirurgicale, Centre Hospitalier Annecy Genevois 1 Av. de l'H\u00f4pital, 74370 Epagny Metz-Tessy, Annecy, France.",
            "firstname": "Marion",
            "initials": "M",
            "lastname": "Servant"
        },
        {
            "affiliation": "R\u00e9animation m\u00e9dico-chirurgicale, Centre Hospitalier Annecy Genevois 1 Av. de l'H\u00f4pital, 74370 Epagny Metz-Tessy, Annecy, France.",
            "firstname": "Albrice",
            "initials": "A",
            "lastname": "Levrat"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive-R\u00e9animation H\u00f4pital de la Croix Rousse, CHU Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Clovis",
            "initials": "C",
            "lastname": "Damieux-Verdeau"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive-R\u00e9animation H\u00f4pital de la Croix Rousse, CHU Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Mehdi",
            "initials": "M",
            "lastname": "Mezidi"
        },
        {
            "affiliation": "Service de R\u00e9animation H\u00f4pital Lyon-sud, Pierre Benite, CHU Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Nathalie",
            "initials": "N",
            "lastname": "Thibert"
        },
        {
            "affiliation": "Service de R\u00e9animation H\u00f4pital Lyon-sud, Pierre Benite, CHU Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Julien",
            "initials": "J",
            "lastname": "Boh\u00e9"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive R\u00e9animation H\u00f4pital Edouard Herriot, CHU Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Alvaro",
            "initials": "A",
            "lastname": "Ballesteros-Calzado"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive R\u00e9animation H\u00f4pital Edouard Herriot, CHU Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Neven",
            "initials": "N",
            "lastname": "Stevic"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive R\u00e9animation, CHU Grenoble Alpes, Grenoble, France.",
            "firstname": "Lena",
            "initials": "L",
            "lastname": "Mahi"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive R\u00e9animation, CHU Grenoble Alpes, Grenoble, France.",
            "firstname": "Florian",
            "initials": "F",
            "lastname": "Sigaud"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive et R\u00e9animation, CHU de Saint-\u00c9tienne, Saint-Etienne, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Margaux",
            "initials": "M",
            "lastname": "Maisonneuve"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive et R\u00e9animation, CHU de Saint-\u00c9tienne, Saint-Etienne, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Guillaume",
            "initials": "G",
            "lastname": "Thiery"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive R\u00e9animation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.",
            "firstname": "Paul",
            "initials": "P",
            "lastname": "Prat"
        },
        {
            "affiliation": "Service de M\u00e9decine Intensive R\u00e9animation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.",
            "firstname": "Arnaud W",
            "initials": "AW",
            "lastname": "Thille"
        },
        {
            "affiliation": "Service de R\u00e9animation Polyvalente, CH Argenteuil, Argenteuil, \u00cele-de-France, France.",
            "firstname": "Safia",
            "initials": "S",
            "lastname": "Haouat"
        },
        {
            "affiliation": "Service de R\u00e9animation Polyvalente, CH Argenteuil, Argenteuil, \u00cele-de-France, France.",
            "firstname": "Gaetan",
            "initials": "G",
            "lastname": "Plantefeve"
        },
        {
            "affiliation": "P\u00f4le Sant\u00e9 Publique, Hospices Civils de Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Evelyne",
            "initials": "E",
            "lastname": "Decullier"
        },
        {
            "affiliation": "P\u00f4le Sant\u00e9 Publique, Hospices Civils de Lyon, Lyon, Auvergne-Rh\u00f4ne-Alpes, France.",
            "firstname": "Muriel",
            "initials": "M",
            "lastname": "Rabilloud"
        },
        {
            "affiliation": "H\u00f4pital Fleyriat, Service de R\u00e9animation Polyvalente, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, Rh\u00f4ne-Alpes, France.",
            "firstname": "Pauline",
            "initials": "P",
            "lastname": "Bernon"
        },
        {
            "affiliation": "H\u00f4pital Fleyriat, Service de R\u00e9animation Polyvalente, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, Rh\u00f4ne-Alpes, France.",
            "firstname": "Yves",
            "initials": "Y",
            "lastname": "Poncelin"
        },
        {
            "affiliation": "H\u00f4pital Fleyriat, Service de R\u00e9animation Polyvalente, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, Rh\u00f4ne-Alpes, France.",
            "firstname": "Julie Catherine",
            "initials": "JC",
            "lastname": "Bonnici"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.",
    "doi": "10.1136/bmjopen-2024-092354\n10.1001/jama.287.3.345\n10.1164/rccm.201208-1523CI\n10.1056/NEJMoa2209041\n10.1164/ajrccm.156.2.9610109\n10.1016/S2213-2600(22)00449-0\n10.1097/CCM.0b013e3182282a5a\n10.1164/ajrccm.159.2.9803106\n10.1016/j.jcrc.2010.12.015\n10.1097/MCC.0b013e32835c5095\n10.1001/jama.2019.7234\n10.1016/S0140-6736(08)60105-1\n10.1513/AnnalsATS.201612-993CME\n10.1056/NEJM199612193352502\n10.5935/0103-507X.20190027\n10.7748/ns2007.09.22.2.44.c4617\n10.4187/respcare.06541\n10.1111/j.1478-5153.2010.00424.x\n10.1111/j.1478-5153.2010.00422.x\n10.4187/respcare.03121\n10.1183/09031936.00010206\n10.1164/rccm.2107138\n10.1016/j.annfar.2006.02.017\n10.1016/j.chest.2021.02.064\n10.1164/rccm.201810-2050CP\n10.1056/NEJMoa2024922\n10.1056/NEJMoa1906759\n10.1097/CCM.0000000000000748\n10.1164/rccm.201602-0320OC\n10.4187/respcare.09276\n10.5114/ait.2023.125584\n10.1186/s13613-019-0483-1\n10.1002/14651858.CD004127.pub3\n10.1001/jama.2016.2711\n10.1001/jama.2019.14901\n10.1056/NEJMoa1903297\n10.1016/S2213-2600(19)30048-7",
    "journal": "BMJ open",
    "keywords": [
        "Adult intensive & critical care",
        "Clinical Trial",
        "Respiratory Therapy"
    ],
    "methods": null,
    "publication_date": "2025-02-14",
    "pubmed_id": "39947817\n11790214\n23641924\n36286317\n9279224\n36693401\n21765357\n9927366\n21376523\n23235542\n31184740\n18191684\n28029806\n8948561\n31141083\n17944138\n30914493\n21040258\n20712671\n25425709\n17470624\n12421743\n16698231\n33676997\n31034248\n33528922\n32068366\n25479115\n27626706\n34732586\n37306270\n30671726\n24323843\n26975498\n31577036\n31613432\n30898520",
    "results": null,
    "title": "Applying positive end-expiratory pressure before and during endotracheal tube removal versus extubation with concomitant aspiration: protocol for the randomised controlled multicentre EXSUPEEP trial.",
    "xml": "<Element 'PubmedArticle' at 0x7885050872e0>"
}