This randomized controlled open label trial aims at comparing a weaning strategy including a spontaneous breathing trial as a prerequisite for extubation to a weaning strategy without a spontaneous breathing trial (direct extubation) in patients with readiness to be weaned criteria and considered at low risk of extubation failure. The main endpoint will be the proportion of patients successfully extubated within the 24 hours after randomization as compared to extubation after a successful spontaneous breathing trial (SBT).
Age older than 18 years and < 65 years old
Nasal or oral intubation longer than 24 hours and less than 4 days
Respiratory rate < 35 cycles per minute
SpO2 >90% with FiO2<40% and PEEP<8 cmH2O
Chronic cardiac disease (left ejection fraction below 45%, documented history of cardiogenic pulmonary edema, permanent atrial fibrillation).
Chronic respiratory disease (severe COPD, documented restricted lung disease or obesity-hypoventilation syndrome)
Body mass index > 30 kg/m2
Airway patency problems, including high risk of developing laryngeal edema, inability to deal with respiratory secretions, brain injury, documented swallowing disorders