A Structured Approach to Extubation in Mechanically Ventilated Rats

Mechanical ventilation (MV) is widely used in critical care but is associated with various complications that affect both short- and long-term outcomes, including ventilator-induced lung injury, ventilator-induced diaphragm dysfunction, and ventilator-associated brain injury. These are key components of post-intensive care unit syndrome (PICS). Rodent models are vital for investigating the prolonged impacts and underlying mechanisms of MV, yet standardized post-extubation models remain limited. Extubation is a critical transition step that is often inconsistently performed in existing rat models, leading to failures and complications. This study presents a four-step structured extubation approach for Sprague-Dawley rat models of MV, designed to optimize the transition from MV to spontaneous breathing while minimizing extubation-related complications. The approach involved: (1) initiating weaning by reducing propofol sedation to 50% and assessing readiness via respiratory rate, chest displacement, arterial blood gases, and reflexes; (2) preparing for extubation through airway clearance and maintenance of oxygenation; (3) executing extubation with maintained sedation and controlled tube removal; and (4) providing post-extubation care involving continuous monitoring and oxygen support. Validated through 20 successful extubations following initial failures, this model offers a valuable platform for studying the long-term effects of MV, particularly in the context of PICS. This approach is optimized for 6 h of MV and is assumed to be extendable to other strains and longer ventilation durations, although such adaptations require careful validation and monitoring to ensure reliability and animal welfare.