Overview of Extubation

Extubation is when the doctor takes out a tube that helps you breathe.

Sometimes, because of illness, injury, or surgery, you need help to breathe. Your doctor or anesthesiologist (a doctor who puts you to “sleep” for surgery) puts a tube (endotracheal tube, or ETT) down your throat and into your windpipe. This helps to get air into and out of your lungs. The process is called intubation. Extubation is taking that tube out.

When Does the Doctor Remove It?

The drugs that put you to sleep during surgery (general anesthesia) may also hold down your breathing. That’s why you sometimes need the ETT in the first place. But the tube is uncomfortable, and you don't need it if you can breathe on your own. This typically happens as you start to wake up. If you're alert, can cough strongly, and don't have a lot of mucus in your lungs, your doctor will plan for extubation.

If needed, they'll give you a drug to reverse the effects of any drugs they used to paralyze your muscles. They may have used them to ease the way when they put the tube in.

They'll test to make sure you can take in enough air with each breath. They'll also make sure that your reflexes are strong enough to protect your airway from food or other debris. This is especially true if you’ve had emergency surgery, because you may have food in your stomach.

If you have an ETT because you're sick or hurt, it may be in place for as long as a couple of weeks. You may be awake as you use it. In these cases, the hospital staff often does more involved tests and trials before they decide that they can safely remove it for good. That’s because there can be serious results if you can’t breathe on your own, including brain damage and death.

How Is the Tube Removed?

Once the doctor is sure that it’s safe to remove the ETT, it's quite simple to take it out.

The doctor will take off any tape that holds it in place and make sure your airway is clear. A small suction tool will clear any debris in the area. They'll quickly deflate the small “cuff” built into the ETT that helped hold it in place. Then your doctor will typically tell you to take a deep breath and then exhale or cough, and they’ll gently pull out the tube. That helps you cough any debris safely up into your mouth, rather than inhaling it into your lungs.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on July 22, 2019

Sources

SOURCES:

Merck Manual: "Respiratory Failure."

UpToDate: “Extubation management in the adult intensive care unit,” “Extubation during anesthesia.”

Winchester Hospital Health Library: “Intubation and Mechanical Ventilation.”

Henry Frysh, MD, Atlanta. 

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