Current research is focusing on preventing extubation failure, especially in the most challenging cases. The use of weaning protocols – written or computerized – attempts to early identify patients who are able to breathe spontaneously and to hasten extubation, resulting in better outcomes. Nevertheless, individualized care is needed in the most vulnerable patients, trying to prompt weaning without exposing patients to unnecessary risks. The results of large randomized controlled trials give an overall incidence of extubation failure relatively ‘low’ (10–20%) for the general ICU population. However, the individual risk of reintubation can become unacceptably high in some at-risk populations with an extremely high mortality in case of extubation failure.

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