Are we fully aware of extubation?

Have you ever visited someone in the intensive care unit (ICU)? Or have you ever had a doctor explain to you about the process of breathing while preparing for surgery? One of the things you hear at such times is that they are putting in a "breathing tube." So, just like putting in this tube, removing it is also a very important, planned process. In medicine, removing that tube is what we call "extubation." Today, let's talk about this simply, in a way that you can understand.

First, let's see what intubation is?

Before we talk about extubation, let's briefly review intubation. Simply put, this is something the medical team does to save your life when you're having trouble breathing on your own for some reason. They insert a flexible plastic tube, called an endotracheal tube (ETT) , through your mouth into your windpipe (the main airway).

Think of it this way: our lungs are like the engine of a car. They need constant air (oxygen) to work. Just as a car won't move if there's a traffic jam, if your airway is blocked or your breathing is weak, oxygen won't reach your lungs. At that point, this tube is inserted, and a machine, a ventilator, is connected to it, and you are given the amount of oxygen you need. This is called intubation.

Now you probably understand what extubation is. That is, the process of carefully removing the tube that was in place after the medical team is confident that you can breathe well on your own again, without any help.

In what cases is extubation performed?

This doesn't happen to everyone at the same time or in the same way. It depends on the reason you were put on the tube and how stable your health is.

After surgery

When you have major surgery, you are put completely to sleep. We call it general anesthesia . These anesthetic drugs temporarily disable the muscles that control your breathing. At that time, the doctors insert this breathing tube to make sure you get the right amount of oxygen throughout the surgery.

After the surgery is successfully completed, the medical team will remove the tube as soon as the effects of the anesthetic wear off and you are able to breathe on your own again. In most cases, the tube will have been removed by the time you regain consciousness. So you may not even remember it. In this case, the tube may have been in place for as short a time as an hour or two.

Due to illness or accident

When a person is intubated because they can't breathe due to an accident, a severe infection (like pneumonia), or another serious illness, the process for removing the tube is a little different. This person is usually in the intensive care unit (ICU).

Before removing the tube, the doctors need to make sure you can breathe on your own. They will do a special test for this. It's called a Spontaneous Breathing Test (SBT) .

Sometimes you may not pass this test the first time. This is called "weaning failure." This is normal. If this happens, the doctor will wait until you are a little better and then do this test again in a day or two.

What are the main reasons for intubation?

To perform an extubation, an intubation must first be performed. Here are some common reasons for it. Let's put these in a table like this to understand them clearly.

What are the steps involved in the extubation process?

Okay, now let's see how a doctor or a trained nurse would remove this tube. This is not something that can be pulled out all at once. There are a few steps to it.

1. Preparing the patient: First, the head of the bed will be raised high. You will be brought into a sitting position. This will help air flow into the lungs and reduce the risk of things like saliva getting into the lungs after the tube is removed.

2. Suctioning: Next, a special device (suction device) is used to remove all the mucus, saliva, and other unwanted substances from your mouth, throat, and breathing tube. This is very important, because otherwise, these substances can get into your lungs when the tube is removed.

3. Releasing the tube: The strap or tape that holds the tube to your face is carefully removed.

4. Separation from the ventilator: The tube is disconnected from the ventilator to which it is connected.

5. Removing the tube: Now is the most important part. The doctor will tell you to "take a deep breath and cough." As you cough or exhale, they will pull the tube out in a quick, smooth motion. This is done as you cough, as your vocal cords open, allowing the tube to come out more easily. And the cough will expel anything that's in your throat.

Are you conscious when the tube is removed?

This is a question that many people have. The answer is, sometimes yes, sometimes no.

• After surgery: The tube is often removed before you regain consciousness, while you are still under anesthesia. So it is removed when you wake up.
• If you are in the intensive care unit (ICU): The tube will be removed while you are still conscious, as it is important for you to be conscious and listen to what you are told (for example, cough when told to "cough").

What happens after extubation?

Removing the tube doesn't mean the job is done. The next few hours are very important. The medical team will monitor you very closely.

• Oxygen: Often, after the tube is removed, you will be given a small amount of oxygen through a nasal cannula or an oxygen mask to help your body adjust to the new situation.
• Monitoring: Your blood oxygen level (with a pulse oximeter), heart rate, and blood pressure are continuously checked.
• Cough: Mucus may build up in your throat due to the tube. Therefore, you will be advised to cough frequently to clear it. If necessary, you may also need to suction again to clear your throat.

Are there any complications that can occur during extubation?

As with any medical procedure, there are some minor risks involved in extubation. But remember, the medical team is prepared for all of these.

What are the advantages of extubation?

• A sign of recovery: The biggest benefit is that you can breathe on your own again. That means your lungs and body are getting back to normal.
• Ability to speak: You cannot speak while the tube is in place. After it is removed, you will be able to speak again in a short time. Although your throat may hurt at first and your voice may change slightly, this will go away in a few days. (It will go away in a few days).
• Ability to eat and drink: Similarly, you cannot eat or drink by mouth while the tube is in place. Once the tube is removed and your ability to swallow (gag reflex) is confirmed, you can begin eating again.
• Avoiding long-term risks: There are some risks associated with having a breathing tube in place for a long time (e.g., vocal cord dysfunction, pneumonia, tracheomalacia ). Extubation means you are free from those risks.

If you or someone in your family has to go through this procedure, don't be afraid or hesitant. Ask your doctor any questions or concerns you may have. They will explain everything to you.

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