Endotracheal extubation.

N Engl J Med 2014;370:e4. DOI: 10.1056/NEJMvcm1300964 Copyright © 2014 Massachusetts Medical Society. Overview Endotracheal extubation refers to the removal of an endotracheal tube from the trachea. This procedure is commonly performed in operating rooms, postanesthesia care units, and intensive care units. This review focuses on extubation of the trachea after general anesthesia and short-term intubation; extubation after long-term intubation involves additional considerations that are beyond the scope of this review. Endotracheal tubes are initially placed to secure an airway for the administration of anesthetic agents, to provide airway protection, or to provide positivepressure mechanical ventilation; these indications are not mutually exclusive. Once endotracheal intubation is no longer needed, extubation is indicated. However, the decision to extubate a patient must be made carefully, particularly because respiratory and airway-related complications are more likely to occur after endotracheal extubation than after endotracheal intubation. Although many of the problems related to endotracheal extubation are minor, serious complications can arise. These complications include cardiovascular stress, pulmonary aspiration, hypoxemia, and even death. Respiratory failure can occur almost immediately or later after extubation. To minimize the possibility of complications related to the removal of an endotracheal tube, a plan for airway management is required. It is important to anticipate the possibilities of difficulties in airway management, cardiopulmonary instability, and the need to reintubate the trachea.