Extubation

Extubation means removing the endotracheal tube.

Purpose

Extubation is done when the person is able breathe on their own or just needs a lower level of breathing support.

Why is it done?

The person will have been weaned from the ventilator. Weaning means to slowly lower the amount of breathing help, until the person in ICU is able to breathe properly themselves. Weaning can happen slowly or quickly. When the doctors feel the person is ready, the person will be extubated.

During extubation, the person will be awake and remain attached to the bedside monitor. They will sit up if they can, and the breathing tube and mouth will be suctioned to remove any secretions. The cuff on the breathing tube will be let down and the tube withdrawn. The person may cough but this is temporary. Usually, an oxygen mask or nasal prongs will be applied to give oxygen support.

The person will be closely monitored to pick up any problems. Sometimes NIV or a high flow nasal cannula will be used. The person will have ongoing monitoring to make sure they are okay.

Sometimes the tube will be removed if it is known that the person is dying. This is to done to give the person dignity during this difficult time. If somebody in ICU dies and a coroner’s case arises, the airway must remain in.

Are there any problems?

It is uncommon to have problems, but some people might have difficulty breathing once they are extubated. This can happen for many reasons, including airway swelling, weakness of breathing muscles and lung infection. If this happens, most people will be able to breathe properly again with treatment. Some might need non-invasive ventilation. A few people will need an endotracheal tube re-inserted and will need to be placed back on the ventilator (breathing machine).

After extubation, it is pretty common to have a sore throat and a harsh voice for a while. Lozenges can help with this.