A mechanical ventilator is a machine that helps your lungs work when it’s hard for you to breathe on your own. This can happen during surgery or due to a critical illness. Ventilators are typically used in an intensive care unit (ICU).

A ventilator keeps your body going by pushing air in and out of your lungs to make sure you receive enough oxygen. It’s connected to your body through a hollow tube, called an endotracheal tube (ETT), that’s inserted into your mouth (or sometimes nose). The ETT then goes inside your windpipe, or trachea, the main airway of the lungs.

To begin mechanical ventilation, you will be put under general anesthesia. Then, doctors will place the ETT into your mouth and snake it into the trachea. This is called intubation.

The process of ETT removal is called extubation.

What happens during and after extubation? Are there any risks from this procedure? Let’s answer these and other questions you may have about extubation.

Extubation is performed as soon as you’re able to breathe on your own, which for example, could be when you wake up from general anesthesia used during surgery. This is because the ETT is uncomfortable, and you don’t need it if you can breathe on your own. Your doctor will most likely start planning extubation as early as the first day of intubation.

First, the doctor will ensure that you can breathe on your own without the ETT. To do this, they’ll test to make sure your lungs get enough oxygen with each breath. This is called a spontaneous breathing test.

Doctors will also check your breathing reflexes to make sure they are able to protect your lungs from food or other debris. This is especially important in case of an emergency surgery because you may still have food in your stomach.

Once they confirm that it’s safe for you to breathe on your own, they will remove the ETT from your trachea. Here’s how it’s done:

  1. The head of the bed will be elevated. Hospital beds have a mechanized control for this.
  2. Then, medical professionals will suction all mucus from your mouth and the ETT itself.
  3. Tape, straps, or other tools used to hold the tube in place will be unsecured.
  4. The tube will be disconnected from the ventilator.
  5. The next step is ETT removal. Your doctor will ask you to take a deep breath and exhale. While you’re exhaling they will deflate a small holder used to keep the ETT in place and gently remove it from your trachea and mouth.
  6. After the ETT is removed, your doctor will ask you to take another deep breath and cough out any mucus you may still have in your lungs.

Weaning failure

Weaning failure happens if you can’t pass the spontaneous breathing test. This means that doctors can’t begin extubation because they aren’t sure you can breathe on your own. Sometimes people require several spontaneous breathing tests and up to a week before they can be extubated. If you fail a breathing test, your doctors will try to find out the underlying issue and address it before giving you another test.

Immediately after extubation, your doctor will put you on supplemental oxygen to make sure you’re getting enough oxygen with your breaths. It usually comes in an oxygen mask or a nasal cannula.

Doctors will ask you to take deep breaths and cough every so often to clear out the remaining mucus. They may also perform some additional suctioning of the mucus from your mouth and trachea.

Your medical team will check up on you frequently within the next few hours to make sure you’re doing OK after extubation.

You will most likely be asked to sit in an upright position and even start taking your first steps.

After doctors confirm that you’re ready to eat on your own, you will get your first meal.

There are some risks associated with extubation.

Extubation failure

Extubation failure happens when you need to be intubated again. Usually, it happens within 72 hours after extubation. Extubation failure is not very frequent — it happens in 12 to 14 percent of planned extubations. It’s more common in people over 65 and in those with severe heart or lung diseases. Using BPAP machines (a form of noninvasive ventilation) right after extubation may help avoid extubation failure.

Noisy breathing or sore throat

After the ventilator tube is removed, it’s possible to have post-extubation stridor (the medical term for noisy breathing), as well as a sore throat due to swelling of tissues in the throat.

There are other complications of extubation, but they are much less common.

Extubation refers to the removal of the endotracheal tube from your lungs. It’s done when mechanical ventilation is no longer needed because you can breathe on your own. It’s done as soon as doctors are sure your own breathing gives you enough oxygen.

To prepare for extubation, doctors will give you a spontaneous breathing test. The process of extubation is pretty straightforward and doesn’t require general anesthesia. After extubation, you may get supplemental oxygen.

There are some risks from extubation. The most common are extubation failure and noisy breathing. There are ways to decrease these risks, and your medical team will ensure that extubation is performed in the safest way possible.