{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T15:31:12Z","timestamp":1770910272379,"version":"3.50.1"},"reference-count":28,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,9]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>During recovery from general anaesthesia with tracheal intubation, the tracheal extubation is a necessary step. 22% of anaesthesia-related complications occur after extubation. In a few patients, the hypoxic brain injury and death may occur. Inflation and suction techniques are two common techniques for tracheal extubation; however, it is unclear which technique is superior. In our practice, the suction tracheal extubation is typically performed via a suction catheter, and the tracheal and oropharyngeal secretions are often not completely cleared. Additionally, cough often occurs. When a suction catheter is substituted with a tracheal tube, the clearance of tracheal and oropharyngeal secretions seems to improve. In addition, even without prior tracheal and oropharyngeal suctions before tracheal extubation, the tracheal and oropharyngeal secretions can be effectively cleared when a tracheal tube is used as a suction catheter. This study was designed to investigate the use of tracheal tubes as suction catheters in awake suction tracheal extubation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>\n                      This single-centre, single-blinded, prospective, non-inferiority, randomised controlled trial will include 600 patients (aged 18\u201365 years, American Society of Anesthesiologists score &lt;grade\u2009III) who will undergo elective surgery. All participants will receive general anaesthesia and be randomly divided into four groups: Inflation, Suction\n                      <jats:sub>suction catheter<\/jats:sub>\n                      , Suction\n                      <jats:sub>tracheal tube-1<\/jats:sub>\n                      and Suction\n                      <jats:sub>tracheal tube-2<\/jats:sub>\n                      groups. In the Inflation group, a positive airway pressure will be given via the anaesthesia machine during awake tracheal extubation. In the Suction\n                      <jats:sub>suction catheter<\/jats:sub>\n                      group, negative pressure suction will be implemented during awake tracheal extubation by inserting a suction catheter into the trachea. In the Suction\n                      <jats:sub>tracheal tube-1<\/jats:sub>\n                      and Suction\n                      <jats:sub>tracheal tube-2<\/jats:sub>\n                      groups, negative pressure suction will be applied during awake tracheal extubation by directly connecting the tracheal tube with a negative pressure suction device. In the Inflation, Suction\n                      <jats:sub>suction catheter<\/jats:sub>\n                      and Suction\n                      <jats:sub>tracheal tube-1<\/jats:sub>\n                      groups, the tracheal and oropharyngeal suctions under anaesthesia state will be carried out before cuff deflation and removal of the tracheal tube. In the Suction\n                      <jats:sub>tracheal tube-2<\/jats:sub>\n                      group, the tracheal and oropharyngeal suctions will not be performed. The primary outcome is the incidence of blood oxygen saturation &lt;92% within 10 min after tracheal extubation. The secondary outcomes include the dose of general anaesthetics, the duration of surgery and anaesthesia, the duration in the postanaesthesia recovery room (PACU), the length of hospital stay, the airway complications before leaving the PACU, the respiratory intervention before leaving the PACU and the postoperative complications within 3\u2009days.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>\n                      This study was approved by the Ethics Committee of Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzho University of Chinese Medicine (Permit No. K2022-162-01, Chairperson Professor Mingzhen Xu) on 17 October 2022 and was registered at the Chinese Clinical Trial Registry (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.chictr.org.cn\/usercenter.aspx\">https:\/\/www.chictr.org.cn\/usercenter.aspx<\/jats:ext-link>\n                      ) on 18 November 2022 (identifier ChiCTR2200065904). The study results will be disseminated through peer-reviewed journals, professional societies and meetings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ChiCTR2200065904.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103123","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T14:40:44Z","timestamp":1770907244000},"page":"e103123","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Awake suction tracheal extubation using a tracheal tube as a suction catheter: study protocol for a randomised controlled non-inferiority trial"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8532-6877","authenticated-orcid":false,"given":"Gengzhi","family":"Wen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital,The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital,The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinyao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital,The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuju","family":"Pu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital,The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cuifang","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital,The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lianqing","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital,The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bowan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shenzhen Traditional Chinese Medicine Hospital,The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong, PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"2026021206403492000_16.2.e103123.1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/80.6.767"},{"key":"2026021206403492000_16.2.e103123.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2008.05792.x"},{"key":"2026021206403492000_16.2.e103123.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2010.06331.x"},{"key":"2026021206403492000_16.2.e103123.4","first-page":"147","article-title":"Tracheal extubation with suction vs. positive pressure during emergence from general anaesthesia in adults: A randomised controlled trial","volume":"37","author":"L\u2019Hermite","year":"2018","journal-title":"Anaesth Crit Care Pain Med"},{"key":"2026021206403492000_16.2.e103123.5","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/81.5.692"},{"key":"2026021206403492000_16.2.e103123.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2012.07075.x"},{"key":"2026021206403492000_16.2.e103123.7","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/44.6.601"},{"key":"2026021206403492000_16.2.e103123.8","doi-asserted-by":"crossref","first-page":"44","DOI":"10.7748\/ns2007.09.22.2.44.c4617","article-title":"A practical guide to extubation","volume":"22","author":"Scales","year":"2007","journal-title":"Nurs Stand"},{"key":"2026021206403492000_16.2.e103123.9","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03121"},{"key":"2026021206403492000_16.2.e103123.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2005.04235.x"},{"key":"2026021206403492000_16.2.e103123.11","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200212000-00058"},{"key":"2026021206403492000_16.2.e103123.12","doi-asserted-by":"crossref","first-page":"1772","DOI":"10.1097\/00000539-200212000-00057","article-title":"Administration of oxygen before tracheal extubation worsens gas exchange after general anesthesia in a pig model","volume":"95","author":"Loeckinger","year":"2002","journal-title":"Anesth Analg"},{"key":"2026021206403492000_16.2.e103123.13","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1097\/ALN.0000000000000161","article-title":"Pulmonary function after emergence on 100% oxygen in patients with chronic obstructive pulmonary disease: a randomized, controlled trial","volume":"120","author":"Kleinsasser","year":"2014","journal-title":"Anesthesiology"},{"key":"2026021206403492000_16.2.e103123.14","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181da832d"},{"key":"2026021206403492000_16.2.e103123.15","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181cded07"},{"key":"2026021206403492000_16.2.e103123.16","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2044.2002.02865.x"},{"key":"2026021206403492000_16.2.e103123.17","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/71.6.788"},{"key":"2026021206403492000_16.2.e103123.18","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000217211.12232.55"},{"key":"2026021206403492000_16.2.e103123.19","doi-asserted-by":"publisher","DOI":"10.1007\/BF03011357"},{"key":"2026021206403492000_16.2.e103123.20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.313.7048.36"},{"key":"2026021206403492000_16.2.e103123.21","doi-asserted-by":"crossref","first-page":"109786","DOI":"10.1016\/j.jclinane.2020.109786","article-title":"Airway management strategy for accidental tracheal extubation in the prone position: A simulation study","volume":"63","author":"Yamamoto","year":"2020","journal-title":"J Clin Anesth"},{"key":"2026021206403492000_16.2.e103123.22","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00000542-196911000-00024","article-title":"Avoidance of hypoxemia during endotracheal suction","volume":"31","author":"Urban","year":"1969","journal-title":"Anesthesiology"},{"key":"2026021206403492000_16.2.e103123.23","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1097\/00000542-196911000-00023","article-title":"Atelectasis following tracheal suction in infants","volume":"31","author":"Brandstater","year":"1969","journal-title":"Anesthesiology"},{"key":"2026021206403492000_16.2.e103123.24","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/00000658-197107010-00004","article-title":"Prevention of hypoxia during endotracheal suction","volume":"174","author":"Fell","year":"1971","journal-title":"Ann Surg"},{"key":"2026021206403492000_16.2.e103123.25","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1111\/j.1365-2044.1974.tb00740.x","article-title":"Letter: Laryngotracheal toilet before extubation","volume":"29","author":"Jamil","year":"1974","journal-title":"Anaesthesia"},{"key":"2026021206403492000_16.2.e103123.26","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1213\/00000539-199109000-00006","article-title":"Emergence airway complications in children: a comparison of tracheal extubation in awake and deeply anesthetized patients","volume":"73","author":"Patel","year":"1991","journal-title":"Anesth Analg"},{"key":"2026021206403492000_16.2.e103123.27","first-page":"441","article-title":"Extubation in adult patients: who, what, when, where, how, and why?","volume":"11","author":"Kempen","year":"1999","journal-title":"J Clin Anesth"},{"key":"2026021206403492000_16.2.e103123.28","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1177\/0310057X9101900310","article-title":"Level of Consciousness on Arrival in the Recovery Room and the Development of Early Respiratory Morbidity","volume":"19","author":"Parr","year":"1991","journal-title":"Anaesth Intensive Care"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-103123","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T14:40:47Z","timestamp":1770907247000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-103123"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,12]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2025-103123"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-103123","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}