EXtubation Related Complications - the EXTUBE Study (EXTUBE)

NCT ID: NCT06442930

Last Updated: 2025-12-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

3000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-04-14

Study Completion Date

2026-12-31

Brief Summary

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EXTUBE is an international, multicentre, prospective cohort study evaluating the incidence, risk factors, and outcomes of extubation-related complications and describing clinical practices related to extubation after general anesthesia or after critical illness in the operating room (OR), out of OR anesthesia location or intensive care unit (ICU).

Detailed Description

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Globally, over 200 million people each year require extubation. While routinely performed, extubation is a skilled and potentially high-risk procedure that should be performed only when physiologic, pharmacologic, and contextual conditions are optimal. Complications at this stage of patient care can result in decreased oxygen delivery to the brain and body, sometimes leading to serious adverse events such as cardiac arrest, brain damage, or death. Indeed, one quarter of airway complications that result in death or brain death occur at the time of extubation.

Despite the frequency of extubation and the potential for life-threatening complications, there is a lack of systematic data on the rate and circumstances under which these severe complications occur. The limited data indicate 10-30% of extubations may lead to severe complications, depending on the population and outcome definition. However, the certainty of these estimates is severely limited because they are based on studies that are small, mostly single-center, based on clinician recall, only capture a small portion of extubation complications (e.g., malpractice claims), or do not reflect current clinical practice. In addition, most lack a denominator and exclude successful extubations, making estimates of actual complication rates and risk factors impossible.

There has been no large study of extubation techniques or adherence to guidelines, so procedural factors associated with complications must be elucidated. While adherence to clinical practice guidelines has not been formally evaluated, surveys show non-adherence to some best practices and considerable variation in practice, and data from audits and medicolegal claims show that lack of adherence to best practices is frequently at the root cause of severe adverse extubation outcomes, with half of the complications deemed preventable. Therefore, data on the frequency and nature of extubation complications, patient and procedural risk factors for complications, and guideline adherence rates are needed before these preventable events can be addressed.

EXTUBE (EXtubation related complications - an international observational study To Understand the impact and BEst practices in the operating room and intensive care unit) is an international, multicenter, prospective cohort study

The primary objective of this study is to determine the incidence of severe extubation-related complications within 60 minutes after extubation in adults who have undergone mechanical ventilation for general anesthesia or critical illness. The secondary objectives are to determine: 1) the incidence of mild extubation complications; 2) patient- and procedure-related risk factors for extubation complications; 3) the association between extubation complications and outcomes until hospital discharge; and 4) the rate of adherence to extubation clinical practice guidelines.

Conditions

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Extubation

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

* Adult patients (≥18 years old)
* Undergoing extubation of an endotracheal tube (including index extubation and re-extubations) after general anesthesia in the OR, out of OR anesthesia location or ICU
* Undergoing extubation during the specified enrollment window

Exclusion Criteria

* Patients will be excluded if the extubation is performed in the context of withdrawal of life support measures,
* Patients will be excluded if the extubation is performed for tracheostomy decannulation

For each patient who is not included, reasons for exclusion will be reported.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Health Network, Toronto

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Matteo Parotto, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

UHN

Locations

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University of Arkansas for Medical Sciences

Little Rock, Arkansas, United States

Site Status COMPLETED

Oregon Health & Science University

Portland, Oregon, United States

Site Status COMPLETED

The University of Texas Health Science Center

Houston, Texas, United States

Site Status COMPLETED

Royal North Shore Hospital

Sydney, New South Wales, Australia

Site Status ACTIVE_NOT_RECRUITING

The Northern Hospital

Melbourne, Victoria, Australia

Site Status COMPLETED

Eastern Health - Box Hill Hospital

Melbourne, Victoria, Australia

Site Status COMPLETED

Eastern Health - Maroondah Hospital

Melbourne, Victoria, Australia

Site Status COMPLETED

Eastern Health - Angliss Hospital

Melbourne, Victoria, Australia

Site Status COMPLETED

Surrey Memorial Hospital

Surrey, British Columbia, Canada

Site Status ACTIVE_NOT_RECRUITING

The Moncton Hospital

Moncton, New Brunswick, Canada

Site Status COMPLETED

Niagara Health - Marotta Family Hospital

Saint Catharines, Ontario, Canada

Site Status RECRUITING

St. Michael's Hospital

Toronto, Ontario, Canada

Site Status COMPLETED

Mount Sinai Hospital

Toronto, Ontario, Canada

Site Status COMPLETED

University Health Network - Toronto General Hospital

Toronto, Ontario, Canada

Site Status COMPLETED

University Health Network - Toronto Western Hospital

Toronto, Ontario, Canada

Site Status COMPLETED

Galway University Hospitals

Galway, , Ireland

Site Status NOT_YET_RECRUITING

Tan Tock Seng Hospital

Singapore, , Singapore

Site Status COMPLETED

Countries

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United States Australia Canada Ireland Singapore

Central Contacts

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Matteo Parotto, MD, PhD

Role: CONTACT

Phone: +1 416 340 3567

Email: [email protected]

Shayan Wasim, MPH, BSc

Role: CONTACT

Phone: +1 416 340 4800

Email: [email protected]

Facility Contacts

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Jennifer L Tsang, MD, PhD, FRCPC

Role: primary

William K Dechert, MSc

Role: backup

John Laffey, MD, MA, DSc, MRIA

Role: primary

Celia Thomas, MSc

Role: backup

Other Identifiers

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4850

Identifier Type: OTHER

Identifier Source: secondary_id

24-5811

Identifier Type: -

Identifier Source: org_study_id