Objective To optimize the ways of extubation after tracheotomy.Methods From August, 2016 to April, 2018, 118 patients after tracheotomy for brain injury were divided into early extubation group (n=74) and conventional extubation group (n=44). The success rate and tolerance of extubation were compared, and the biochemical markers of blood were tested before and seven days after extubation. The early extubation group was divided into disposable extubation group (n=37) and occlusion tube-extubation group (n=37), and their success rates of extubation were compared.Results There was no significant difference in success rate between the early extubation group and the conventional extubation group (χ2=0.016, P>0.05). The tolerance was less in the early extubation group on the first day of extubation (χ2=4.909, P<0.05), and it was not different seven days and 15 days after extubation (χ2<1.995, P>0.05). The procalcitonin, hypersensitive C reactive protein and white blood cell count decreased (t>2.680, P<0.05), and hemoglobin and albumin increased seven days after extubation (t>11.620, P<0.001). There was no significant difference in the success rate between the disposable extubation group and the occlusion tube-extubation group (χ2<2.902, P>0.05).Conclusion Satisfactory cough and deglutition reflex are the core indexes of successful extubation, other indications may not influence on the success of extubation but on tolerance. Extubation may benefit to control the complications of tracheotomy. The disposable extubation is more recommended.