How to remove an endotracheal tube.

Rationale and key points The decision to remove an endotracheal tube (extubation) is taken when the patient achieves adequate airway control. This requires an effective cough and an acceptable level of consciousness. Practitioners should be able to identify when a patient is ready for endotracheal tube removal and to recognise contraindications and potential complications. ▶ The Glasgow Coma Scale should be used to assess the patient's level of consciousness. Extubation should not be performed on patients with a score of 8 or less. ▶ The patient is suitable for endotracheal tube removal if their peak expiratory flow rate is more than 60L/minute. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice when managing a patient with an endotracheal tube. 2. How this article could be used to educate your colleagues. Subscribers can upload their reflective accounts at: rcni.com/portfolio .