Evidence map›Paper›PMID 40745279›Full record

Trial reportBMC anesthesiology2025

A comparison of deep versus awake tracheal extubation in adults: a randomized controlled trial.

Michael A Lee, Peter W Schenke, Matthew R Faller, Henry R DeYoung, Ashley R Adams

Registry-linked trialAbstract readRandomized Controlled TrialComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05361850 (Comparison of Deep Versus Awake Tracheal Extubation in Adults), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05361850 nacompletednot on this map

Comparison of Deep Versus Awake Tracheal Extubation in Adults

TypeinterventionalSponsorUnited States NavyRan2020 to 2023Enrolled220ConditionsAirway Complication of Anesthesia, Respiratory Complications of CareArmsExtubation
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Michael A LeeNaval Medical Center Camp Lejeune, 100 Brewster Blvd Camp Lejeune, Jacksonville, NC, 28547, USA. michael.a.lee32.mil@health.mil.
Peter W SchenkeNaval Medical Center Portsmouth, 620 John Paul Jones Circle, VA, 23708, Portsmouth, USA.
Matthew R FallerNaval Medical Center Portsmouth, 620 John Paul Jones Circle, VA, 23708, Portsmouth, USA.
Henry R DeYoungNaval Medical Center Portsmouth, 620 John Paul Jones Circle, VA, 23708, Portsmouth, USA.
Ashley R AdamsNaval Medical Center Camp Lejeune, 100 Brewster Blvd Camp Lejeune, Jacksonville, NC, 28547, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAwake extubation is deemed a generally safe option for tracheal extubation in low-risk patients, while anesthetized, or"deep" extubation is often considered best suited to seasoned providers due to its perceived hazards. However, inadequate data exists about the relative safety of deep and awake extubations in the adult population.

methodsAdult patients (n=220) with favorable airways undergoing elective surgeries under general tracheal anesthesia were enrolled prospectively. Following a standardized volatile anesthetic regimen, patients were randomized to undergo deep or awake tracheal extubation. The primary outcome was the occurrence of at least one airway or respiratory complication. Secondary outcomes included airway interventions, hemodynamic parameters, severe emergence agitation, and sore throat severity.

resultsPre-extubation, awake extubations exhibited an increased rate of any airway and respiratory complications (risk ratio [RR] - 5.1; 95% confidence interval [CI] - 2.8-9.5; p<.001), attributable to greater incidences of cough (RR - 6.8; 95% CI - 3.2-14.3, p>.001) and hypoxemia (RR - 3.6; 95% CI - 1.3-10.6, p=.010). After extubation, a significantly decreased rate of one or more complications occurred in the awake extubation group (RR - 0.7; 95% CI - 0.6-1.0; p=.028). Awake extubations were associated with fewer incidences of airway obstruction (RR - 0.2; 95% CI - 0.1-0.4, p<.001) and apnea (RR - 0.3; 95% CI - 0.1-0.9; p=.025), but higher rates of any severity cough (RR - 2.9; 95% CI - 1.6-5.2; p<.001). Awake extubations required significantly fewer airway interventions after extubation (RR - 0.2; 95% CI - 0.1-0.6; p<.001). No serious adverse events occurred.

conclusionsDeep and awake extubations produce distinct airway and respiratory complication profiles, without either being conclusively safer. The risks posed by each technique during emergence and after extubation should be considered by anesthesia providers when formulating an extubation strategy.

trial registrationThis study was retrospectively registered at clinicaltrials.gov (NCT05361850) on April 23, 2022.

Indexed as

Airway ExtubationAnesthesia, GeneralWakefulnessAdultAgedCoughFemaleHumansIntubation, IntratrachealMaleMiddle AgedProspective StudiesAdult anesthesiaAirway complicationsAwake extubationDeep extubationGeneral endotracheal anesthesiaRandomized controlled trials

Identifiers

PMID40745279
PMCPMC12315347

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.