Challenge of tracheal extubation and tube exchange of a difficult airway: a narrative review.

Abstract

Tracheal extubation is an integral part of airway management.

Even though available data indicated that the incidence of complications immediately after tracheal extubation may be higher than during tracheal intubation, it is significantly underexplored in the scientific literature in comparison with tracheal intubation.

Failure to re-secure the airway during or immediately after tracheal extubation may have fatal consequences. Closed claims analyses have highlighted the seriousness of adverse events occurring postextubation.

Consequently, a well-planned strategy for tracheal extubation is as important as for the intubation and is correctly regarded as a logical extension of an intubation strategy.

This narrative review focusses on the challenges of tracheal extubation and complications of routine and 'at-risk' extubation in adults. It provides the reader with a risk stratification before extubation.

Guidelines for tracheal extubation including advanced techniques for tracheal extubation of patients 'at-risk' are followed by a detailed step-by-step approach for video-assisted tracheal tube exchange in patients with a difficult airway.

COI Statement

Declarations. Conflict of interest: DH, AS, FO, and Matteo Parotto have no conflict of interest. TH has received research grants from the Foundation of Natural Science and Technological Research and from the Maiores Foundation, both in Vaduz, Principality of Liechtenstein.

References:

Cooper RM, Parotto M. Extubation and reintubation of the difficult airway. In: Hagberg and Benumof’s airway management. 5th ed. Elsevier; 2023. p. 853–75.
Mitchell V, Cooper R. Extubation. In: Cook T, Seltz Kristensen M, editors. Core topics in airway management. Cambridge: Cambrigde University Press; 2021. p. 177–84.
Benham-Hermetz J, Mitchell V. Safe tracheal extubation after general anaesthesia. BJA Educt. 2021;21:446–54.
Heidegger T. Extubation of the difficult airway - an important but neglected topic. Anaesthesia. 2012;67:213–5.
Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, Fiadjoe JE, Greif R, Klock P, Allan Jr; Mercier D, Myatra SN, O’Sullivan, EP; Rosenblatt WH, Sorbello M, Tung A. American society of anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136:31–81.

Article info

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Doi:

10.1007/s00540-025-03510-0

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Springer

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