Awake suction tracheal extubation using a tracheal tube as a suction catheter: study protocol for a randomised...

During recovery from general anaesthesia with tracheal intubation, the tracheal extubation is a necessary step. 22% of anaesthesia-related complications occur after extubation. In a few patients, the hypoxic brain injury and death may occur. Inflation and suction techniques are two common techniques for tracheal extubation; however, it is unclear which technique is superior. In our practice, the suction tracheal extubation is typically performed via a suction catheter, and the tracheal and oropharyngeal secretions are often not completely cleared. Additionally, cough often occurs. When a suction catheter is substituted with a tracheal tube, the clearance of tracheal and oropharyngeal secretions seems to improve. In addition, even without prior tracheal and oropharyngeal suctions before tracheal extubation, the tracheal and oropharyngeal secretions can be effectively cleared when a tracheal tube is used as a suction catheter. This study was designed to investigate the use of tracheal tubes as suction catheters in awake suction tracheal extubation.

This single-centre, single-blinded, prospective, non-inferiority, randomised controlled trial will include 600 patients (aged 18-65 years, American Society of Anesthesiologists score suction catheter, Suction_{tracheal tube-1} and Suction_{tracheal tube-2} groups. In the Inflation group, a positive airway pressure will be given via the anaesthesia machine during awake tracheal extubation. In the Suction_{suction catheter} group, negative pressure suction will be implemented during awake tracheal extubation by inserting a suction catheter into the trachea. In the Suction_{tracheal tube-1} and Suction_{tracheal tube-2} groups, negative pressure suction will be applied during awake tracheal extubation by directly connecting the tracheal tube with a negative pressure suction device. In the Inflation, Suction_{suction catheter} and Suction_{tracheal tube-1} groups, the tracheal and oropharyngeal suctions under anaesthesia state will be carried out before cuff deflation and removal of the tracheal tube. In the Suction_{tracheal tube-2} group, the tracheal and oropharyngeal suctions will not be performed. The primary outcome is the incidence of blood oxygen saturation <92% within 10 min after tracheal extubation. The secondary outcomes include the dose of general anaesthetics, the duration of surgery and anaesthesia, the duration in the postanaesthesia recovery room (PACU), the length of hospital stay, the airway complications before leaving the PACU, the respiratory intervention before leaving the PACU and the postoperative complications within 3 days.

This study was approved by the Ethics Committee of Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzho University of Chinese Medicine (Permit No. K2022-162-01, Chairperson Professor Mingzhen Xu) on 17 October 2022 and was registered at the Chinese Clinical Trial Registry (https://www.chictr.org.cn/usercenter.aspx) on 18 November 2022 (identifier ChiCTR2200065904). The study results will be disseminated through peer-reviewed journals, professional societies and meetings.

ChiCTR2200065904.