From Boston Medical Center, Boston.
N Engl J Med. 2014 Jan 16;370(3):e4. doi: 10.1056/NEJMvcm1300964.
Endotracheal extubation should be performed without causing trauma, while maintaining adequate oxygenation and ventilation. The equipment needed to provide suction, ventilation, and reintubation should be readily available. If extubation is judged to be unsafe, the procedure should be postponed and the patient reevaluated. Most complications related to extubation are preventable. Before performing extubation, the clinician must carefully prepare the medical resources needed to address reasonably foreseeable complications. A failed extubation can lead to a precipitous deterioration in the patient's condition, and attempts to improvise solutions under these challenging circumstances are rarely satisfactory.
气管插管拔管时不应造成创伤，同时要保持充足的氧合和通气。应备好提供吸引、通气和重新插管的设备。如果判断拔管不安全，应推迟操作并重新评估患者。与拔管相关的大多数并发症是可以预防的。在进行拔管前，临床医生必须仔细准备好处理可预见并发症所需的医疗资源。拔管失败可导致患者病情迅速恶化，在这种充满挑战的情况下临时想办法很少能令人满意。
