Related Experiment Video
Updated: Sep 12, 2025
Author Spotlight: Advancing Awake Nasotracheal Intubation with Flexible Video Rhino-Laryngoscopes
Published on: August 2, 2024
Effects of Preoxygenation With Intratracheal Suctioning During Extubation: An Alternating Cluster-Controlled Trial
Josef Prazak1, Noëlle Valérie Schenk1,2, Joerg C Schefold1
1Department of Intensive Care Medicine, Inselspital, University Hospital Bern, Bern, Switzerland.
Objective:
Extubation is a critical event for patients in the ICU. Preoxygenation and intratracheal suctioning during extubation may contribute to atelectasis. However, evidence concerning extubation procedures and their impact on patient outcomes is limited. This study aimed to compare two extubation strategies: one using preoxygenation with 100% F io2 combined with intratracheal suctioning, and the other using a low F io2 (35%) without suctioning.
Design:
A single-center, alternating cluster-controlled trial.
Setting:
Tertiary level interdisciplinary adult ICU.
Patients:
A total of 3,675 patients were randomized into two groups: 1) F io2 100% with suctioning ( n = 1,877, 51.1%) and 2) F io2 35% without suctioning ( n = 1,798, 48.9%).
Interventions:
Comparison of two extubation strategies: F io2 100% with suctioning vs. F io2 35% without suctioning.
Measurements And Main Results:
The primary outcome was a composite of reintubation and/or noninvasive ventilation within 48 hours after extubation. Secondary outcomes included the components of the primary endpoint, the need for nasal high-flow oxygenation or changes in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) after extubation. Differences in outcomes were assessed via adjusted logistic or linear regression models. The low F io2 /no suctioning strategy resulted in a 23% reduction in the primary outcome (odds ratio 0.77; 95% CI, 0.60-0.98; p = 0.032) compared with the high F io2 /suctioning group. In addition, the P/F ratio in the low F io2 /no suctioning group was significantly higher, with an estimated mean difference of 4.72 kPa (95% CI, 4.12-5.32; p < 0.001).
Conclusions:
Extubation with a low-inspired oxygen fraction and without suctioning appears safe and may improve patient-relevant outcomes. Further research is necessary to optimize F io2 settings and secretion management during extubation in critically ill patients.
More Related Videos
04:43Endotracheal Intubation via Tracheotomy and Subsequent Thoracotomy in Rats for Non-Survival Applications
Published on: March 15, 2024
05:39Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
01:26Tracheostomy Suctioning I: Pre-Procedural Steps
Equipment Required
First, gather all necessary equipment: a sterile suction catheter, a sterile disposable container, sterile gloves, a towel or...
01:23Tracheostomy Suctioning II: Procedure
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...