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.
Adult patient
Intubated for more than 48 hours
Patient for whom extubation is prescribed by the patient's physician
Headboard restriction>30°.
Decision to limit active treatment in advance of reintubation
Protected person (under guardianship or curatorship)
Person under court protection
Parallel
Suctionning extubation
Procedure/SurgeryWe 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.
No suctionning Extubation
Procedure/SurgeryIn 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.
Respiratoy/oxygenation index (ROX index)
Rox index will be assessed 3 hours after extubation by an investigator with no information about randomization (blind assessment)
Mechanical ventilation weaning failure
Weaning failure corresponds with death or new intabution
ROX index evolution
Rox index will be assessed 3 times after extubation in order to evaluate its evolution (blind assessment) : 1. 30 minutes after extubation 2. 1 hour after extubation 3. 3 hour after extubation
Pneumonia after extubation
Rate of hospital-acquired pneumonia confirmed by an investigator
Airway clearance technique
Use of any airway clearance technique after extubation : * nasotracheal suction * respiratory physiotherapy * bronchial fibroscopy
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