1. Readiness to wean: 1.GCS > 8 2. pH > 7.25 3. PF ratio of >150 4. Systolic blood pressure > 90 mm Hg without the use of significant dosage of vasopressors 5. Cause of respiratory failure had improved
2. Spontaneous Breath Trial: a) Baseline blood gas and clinical parameters to be documented. b) SBT to be performed using either an incremental reduction of pressure support to a PSV of 5-7 cm or by a T-piece trial, which was to be carried out for a duration of 30 minutes to a maximum of 2 hours. c) Assess intolerance to SBT: Rise in pCO2> 8mm Hg or an absolute value > 50 mm Hg PO2< 50-60 mm Hg or SpO2< 90% on FiO2 > 50% pH < 7.32 or decrease more than 0.07 units RR > 35/min or increase of > 50% New onset hypotension (SBP < 90mm Hg),increase in SBP more than 20% or new onset arrhythmia Tachycardia with a heart rate > 140 beats/min or increase more than 20% Worsening of GCS
3. Extubation screen : Appropriate alertness and muscle function (assessed by GCS and head lift-off bed for > 5 seconds) Adequate cough reflex (assessed via suctioning frequency which should not have been more frequent once every two hours) Adequate airway patency assessed using a cuff-leak test
Extubation If the patient satisfied all of the above criteria, they were extubated to either room air, high flow oxygen or NIV depending on the underlying condition.