How to optimize extubation?

Extubation on vasopressors was controversial until a recent study [[7]] that suggested that extubation on low-dose vasopressors ( 0.1 g/kg/min) could be safe and associated with a lower mortality and a shorter ICU length of stay. In a recent randomized trial of patients receiving mechanical ventilation [[3]], a 30-min PSV-SBT resulted in a significantly higher rate of successful extubation than a 2-h T-piece SBT, without significantly increasing reintubation. To anticipate airway failure before extubation, cough expiratory peak-flow and the evaluation of the amount of secretions are also important to identify patients at risk to develop airway failure. Extubation failure, defined as the inability to sustain spontaneous breathing after removal of the artificial airway and need for reintubation within 24-72 h or up to 7 days, is associated with high morbidity and mortality, as well as long term disability [[1]]. [Extracted from the article]