Nursing care
Extubation Care: the nurse's role, start to finish
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated September 2026
Short answer
Extubation care nursing management means suctioning above the cuff before it is deflated, then removing the tube on a positive-pressure breath and monitoring closely for the first hour. Stridor in that window is treated as laryngeal oedema until proven otherwise. Readiness criteria, oxygen backup, and airway equipment at the bedside are checked before the tube ever comes out.
When it is done and why
Extubation follows a patient meeting readiness criteria: resolution of the condition that required intubation, adequate oxygenation on low ventilator support, a strong cough and gag reflex, and haemodynamic stability. Spontaneous breathing trials are typically used to confirm the patient can sustain ventilation without the machine before the tube comes out.
Delaying extubation unnecessarily prolongs sedation, ventilator-associated pneumonia risk, and ICU length of stay, but extubating too early risks reintubation, which carries its own morbidity. The nurse's ongoing assessment of respiratory effort, secretions, and mental status feeds directly into the team's decision on timing.
Preparing the patient
Confirm the patient has been fasted appropriately if oral intake is a concern, and hold enteral feeds for the period specified by unit protocol to reduce aspiration risk. Explain the procedure to the patient even if sedated, since hearing is often preserved and anxiety at extubation worsens the work of breathing afterward.
Have oxygen delivery equipment ready at the bedside — nasal cannula, simple mask, or high-flow device as ordered — along with suction, a bag-valve-mask, and reintubation equipment in case of failure. Position the patient upright or semi-Fowler's to optimise diaphragmatic excursion and reduce the risk of aspiration during and after tube removal.
The steps that matter for safety
Before the cuff is deflated, suction the oral cavity and then suction above the cuff, in the subglottic space, to clear secretions that have pooled there. If this pooled fluid is not cleared first, deflating the cuff lets it drop straight into the trachea, and that single step is the difference between a clean extubation and an aspiration event.
Deflate the cuff fully, confirm no air leak resistance, and remove the tube in one smooth motion at the peak of a positive-pressure breath or during a controlled exhalation, following unit protocol. Apply oxygen immediately afterward and encourage the patient to cough to clear any remaining secretions from the upper airway.
During the procedure — the nurse's role
The nurse manages suctioning above the cuff, coordinates the timing of tube removal with the person performing it, and applies oxygen support the moment the tube is out. Reassure the patient throughout, since coughing and gagging are expected and distressing but not usually dangerous on their own.
Assess voice quality immediately after removal — hoarseness is common and usually transient, but stridor is not. Have the physician or rapid response team aware and equipment accessible in case of respiratory distress in the first minutes, since this is the highest-risk window of the entire procedure.
After: monitoring and complications
Monitor respiratory rate, SpO2, work of breathing, and voice quality closely for at least the first hour, with continuous pulse oximetry throughout. Stridor appearing in this window is treated as laryngeal oedema until proven otherwise, and it warrants immediate escalation — racemic epinephrine nebuliser, corticosteroids, or reintubation preparation, depending on severity and unit protocol.
Watch also for laryngospasm, which presents as sudden inability to move air despite respiratory effort, and for aspiration if secretions were not adequately cleared before removal. A weak cough, rising respiratory rate, or falling SpO2 in the hours after extubation can signal fatigue or upper airway swelling and should prompt reassessment rather than reassurance.
Documentation and teaching
Record the time of extubation, the readiness criteria met beforehand, voice and airway assessment immediately after, oxygen device and flow rate applied, and any stridor, distress, or intervention required in the following hours. Note the patient's tolerance of the spontaneous breathing trial that preceded extubation, since this is often reviewed if reintubation later becomes necessary.
Teach the patient to expect a sore throat and hoarse voice for a day or two, and to report any worsening difficulty breathing, noisy breathing, or swallowing trouble immediately rather than waiting. Encourage deep breathing and coughing exercises, and explain why oxygen support continues even though the tube is out, since patients sometimes assume its removal means recovery is complete.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our respiratory practice questions are the closest set to what this page covers.
Common questions
Why suction above the cuff before extubation?
Secretions pool in the subglottic space above an inflated cuff. Suctioning that space before deflation clears it so the fluid does not drop into the trachea and cause aspiration the moment the cuff comes down.
What does stridor after extubation mean?
Stridor in the first hour after extubation is treated as laryngeal oedema until proven otherwise. It requires immediate assessment and often treatment with nebulised epinephrine, corticosteroids, or preparation for reintubation, depending on severity.
What are the criteria for extubation readiness?
The patient should have resolved the condition requiring intubation, tolerate a spontaneous breathing trial, maintain adequate oxygenation on minimal support, have a strong cough and gag reflex, and be haemodynamically stable. Mental status sufficient to protect the airway is also assessed.
What is a typical NCLEX question about extubation complications?
A scenario describes a patient with noisy, high-pitched breathing shortly after extubation and asks for the priority nursing action. The expected answer is to notify the provider immediately and prepare for treatment of laryngeal oedema, not to simply reassure the patient.
How soon can a patient eat or drink after extubation?
Oral intake is usually withheld for a period after extubation, often a few hours, until the swallow reflex and cough are confirmed intact and hoarseness has settled. The exact timing depends on unit protocol and the patient's overall recovery.