06/29/2026
Does 100% oxygen before extubation always make sense?
A recent randomized controlled trial suggests it may not. (https://www.bjanaesthesia.org/article/S0007-0912(26)00349-1/abstract)
Researchers compared the use of 100% FiO₂ with 40% or 70% FiO₂ during anesthetic washout before extubation in adults undergoing elective surgery.
Key findings:
✅ Lower FiO₂ preserved end-expiratory lung volume after extubation.
✅ Ventilation remained more dorsally distributed, suggesting less postoperative atelectasis.
✅ Patients receiving 70% FiO₂ achieved the best oxygen saturation 10 minutes after extubation.
✅ There was no additional benefit of 100% oxygen for postoperative lung mechanics.
Clinical takeaway: Rather than routinely using 100% oxygen during emergence, tailoring FiO₂—particularly around 70%—may help preserve lung function while still providing excellent oxygenation after extubation.
As always, oxygen therapy should be individualized based on the patient’s physiology, surgical procedure, and clinical circumstances.
What is your current extubation practice? Do you routinely use 100% FiO₂, or have you adopted a lower oxygen strategy?
