When should the endotracheal tube be removed?

The removal of an endotracheal tube should occur when the patient can breathe independently. This condition indicates that they have regained sufficient respiratory function to maintain adequate oxygenation and ventilation without assistance. Assessing a patient's ability to breathe on their own often involves evaluating factors such as respiratory rate, effort, tidal volumes, and the ability to maintain a satisfactory blood gas status.

Choosing to remove the tube based on this criterion supports a transition to spontaneous breathing, which is crucial for recovery and promotes normal respiratory mechanics. While sedation levels, the necessity for mechanical assistance, and episodes of apnea can influence the timing and decision-making around extubation, the fundamental requirement lies in the patient’s capacity to breathe without reliance on mechanical support.