What is extubation ?
Extubation refers to the removal of a breathing tube (also called an endotracheal tube).
The purpose of this procedure is to remove the breathing tube from the patient's airway so that they are able to breathe on their own.
What is done?
The patient will have undergone a period of ‘weaning’ from the ventilator (breathing machine). Weaning means gradually reducing the amount of assistance the ventilator is providing until it is determined that the patient is able to breathe adequately for themselves. This process can be rapid or slow. When the doctors feel the patient is ready they will decided to extubate the patient.
The patient will be awake and cooperative and will remain on the patient monitor. They will be sat up(if able to) 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 The cuff on the breathing tube will be let down and the tube withdrawn.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 patient may cough but this is temporary. An oxygen mask will be applied to give extra oxygen and the patient closely monitored to identify any problems. The patient will continued to be monitored closely to ensure the process has been successful.
Under some circumstances the tube will be removed when it has been established that the patient is dying. This is to done to enhance the patient’s dignity during this difficult time.
If the patient dies and there will be a coroner’s case the airway must remain in.
What are the risks?
It is uncommon to have problem however some patients have difficulty breathing once extubated. This occurs for a number of reasons including acute airway swelling, breathing muscle weakness and lung infection. These patients often respond to treatment including nebulising medications, physiotherapy and suctioning, or non-invasive ventilation via BiPAP. A small number however will need to be re-intubated (re-insertion of an breathing tube) and placed back on the ventilator (breathing machine).
The patient’s throat may be sore and their voice harsh for a short period of time. Lozenges can help this.
All Intensive Care procedures carry a degree of risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for the patient and o f course, if you have any questions or concerns, please ask the ICU nurses and doctors.
Extubation Version 1.1 (K Rolls CNC ICCMU) First posted July 200, revised July 2009
The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.