RecruitingNot ApplicableNCT07130123

Endotracheal Suctionning During Positive Pressure Extubation in ICU

Removal of the Intubation Tube Under Positive Pressure With or Without Endotracheal Suctioning During Extubation in Intensive Care: a Prospective Randomised Controlled Trial

Sponsor

Centre Hospitalier Régional d'Orléans

Enrollment

120 participants

Start Date

Oct 3, 2025

Study Type

INTERVENTIONAL

Conditions

Weaning Invasive Mechanical Ventilation Extubation Oxygen Saturation Measurement Mechanical Ventilation With Oral Intubation Rox Index

Summary

The aim of this clinical trial is to evaluate endotracheal suctioning during positive pressure extubation in mechanically ventilated adult patients (over 18 years old) in the intensive care unit (ICU). The main question it aims to answer is whether the intervention improves the respiratory oxygenation index (ROX) three hours after extubation compared to no endotracheal suction during positive pressure extubation. Participants will only need to be extubated by the nursing team in the ICU. Follow-up will consist of evaluating respiratory rate, pulse oximetry and inspired oxygen fraction for three hours following extubation.

Eligibility

Min Age: 18 Years

Inclusion Criteria3

Adult patient
Intubated for more than 48 hours
Patient for whom extubation is prescribed by the patient's physician

Exclusion Criteria8

Headboard restriction\>30°.
Decision to limit active treatment in advance of reintubation
Protected person (under guardianship or curatorship)
Person under court protection
Persons deprived of liberty
Persons not affiliated to a social security scheme
Pregnant or breast-feeding woman
No co-inclusion with a study whose period of interest is follow-up within 3 hours of extubation.

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Interventions

PROCEDURESuctionning extubation

We will remove the intubation tube with endotracheal suctioning during the extubation procedure and maintain positive end expiratory pressure (PEEP) and pressure support. The PEEP level will be 10 cmH2O and the pressure support 7 cmH2O for 2 minutes prior to extubation. The vacuum level will be the maximum level (standard procedure in the unit), i.e. 450 mmHg. The closed-system suction probe is inserted up to the last mark corresponding to 40cm. The size of our closed system is identical for all patients, i.e. 14 french.

PROCEDURENo suctionning Extubation

In the control group, removal of the intubation tube during the extubation procedure is performed with PEEP maintained, without endotracheal suctioning. The PEEP level will be set at 10 cmH2O and the pressure at 7 cmH2O in the 2 minutes prior to extubation.