postextubation

Postextubation refers to the period after the removal of an endotracheal tube from a patient who has required invasive mechanical ventilation. It marks the transition from controlled ventilatory support to spontaneous breathing and ongoing airway management. After extubation, patients are monitored for adequate gas exchange, airway patency, and the ability to protect the airway during swallowing and coughing.

Monitoring and management focus on early detection of respiratory compromise. Clinicians assess work of breathing, oxygenation, and ventilation; arterial blood gases may be obtained as indicated. The most common complication is extubation failure, necessitating reintubation, often within 24 to 72 hours. Risk factors include prolonged prior intubation, advanced age, COPD or other chronic lung disease, obesity, edema, and weakened mental status. Before extubation, spontaneous breathing trials and, in some settings, evaluation for airway edema (for example, cuff leak assessment) are used to guide decisions.

After extubation, supplemental oxygen is provided and, in selected patients, noninvasive ventilation or high-flow nasal cannula therapy may reduce the risk of reintubation. Humidified oxygen and airway clearance strategies help maintain secretions and airway patency. Monitoring continues for signs of stridor, respiratory distress, hypoxemia, or hypercapnia.

Common complications include postextubation stridor, laryngeal edema, airway obstruction, aspiration, atelectasis, and pneumonia. Swallowing assessments and rehabilitation may be indicated to address dysphagia. Prevention measures for at-risk patients may involve pharmacologic therapies and careful airway management; prognosis varies with the underlying condition and response to therapy.