The effect of extraction angle on endotracheal tube extubation force: Simulation and randomized clinical trial

To evaluate the extraction force generated at different extubation angles using a manikin simulation and a randomized clinical trial.

Simulations were performed on a manikin to assess the force generated at extubation angles of 0°, 30°, 45°, 60°, 90° and 120° relative to the ground. The trial compared extraction force and changes in vital signs in patients undergoing general anaesthesia with tracheal intubation followed by extubation at 60° or 90°.

The simulation study found that the extubation force was significantly lower at 45° and 60° than at all other extraction angles. In the trial, extubation at 60° resulted in significantly lower extraction force and systolic blood pressure elevation (n = 23) than extubation at 90° (n = 23).

Findings in a manikin simulation were confirmed by those of a randomized clinical trial, where extubation at 60° required less force than 90°, and was accompanied by less SBP elevation. Extubation at 60° is less invasive than extubation at 90°.