Extubation with positive pressure vs. suctioning for postoperative atelectasis in elderly patients: a randomized clinical trial

INTERVENTION: Suction Group:Tube removal under negative pressure suction: A sterile suction tube is inserted through the tracheal catheter, 1–2 cm beyond its tip; the gas in the cuff is removed while negative pressure is applied (set at 150 mmHg) to draw out the secretions from the airway. With this negative pressure suction in effect, the suction tube and the tracheal catheter are removed simultaneously.;Positive‐Pressure Group:Positive‐pressure tube removal: Switch the ventilator to manual mode, set the Adjustable Pressure Limiting (APL) value at 15–25 cmH2O (with visible movement of the chest wall serving as the criterion for determination), slowly compress the reservoir bag to deliver a large volume of air; at the moment when the patient’s chest wall reaches its maximum expansion (at the end of inhalation), quickly evacuate the air from within the tracheal tube cuff and remove the tracheal tube.; CONDITION: Postoperative pulmonary atelectasis PRIMARY OUTCOME: Incidence of significant pulmonary atelectasis at 30 minutes post‐extubation (defined as LUS score = 2 in any lung region); SECONDARY OUTCOME: Time to first hypoxemia event (measured from extubation);Airway complications (cough, airway obstruction, laryngospasm, gastric content aspiration);Hemodynamic instability (hypotension or hypertension requiring pharmacological intervention);Total Lung Ultrasound Score (LUS);Pain intensity at 24 hours post‐surgery (Numeric Rating Scale, NRS);Incidence of hypoxemia during the recovery period (SpO2 < 90% for > 10 seconds);Airway rescue interventions (Venturi mask, oropharyngeal airway, bag‐mask ventilation, reintubation);Overall recovery status (Postoperative Quality Recovery Scale, PQRS);Incidence of adverse events; INCLUSION CRITERIA: 1.Aged 65 years or older; 2.American Society of Anesthesiologists (ASA) physical status classification I to III; 3.Scheduled for elective non‐cardiac surgery under general anesthesia; 4.Airway management via orotracheal intubation; 5.Postoperative hospital stay of at least 1 day; 6.Voluntarily provide written informed consent;