Liberating from the Ventilator

• Pair daily SAT + SBT once FiO₂ ≤40%, PEEP ≤8, minimal sedation, pressors low or off.
• Run the SBT on a T-piece or PSV 5/5 for 30–120 min; RR >35, SpO₂ <90%, distress, or arrhythmia means failure.
• Extubate after a successful SBT when airway protection and secretion clearance are adequate. After successful SBT and airway assessment, use preventive NIV immediately after extubation in appropriate high-risk patients, particularly those with hypercapnic COPD or cardiac disease. HFNO is an alternative when NIV is contraindicated or not tolerated and may be used between NIV sessions. Monitor closely; do not delay reintubation for established failure.
• Consider tracheostomy assessment when prolonged ventilation or airway protection is likely. Individualize timing using the clinical trajectory, neurological prognosis, secretion burden and patient goals; expected ventilation beyond 7–10 days or a low GCS alone does not mandate an early procedure.

First tests: Readiness assessment and spontaneous breathing trial.

Only if indicated: Arterial blood gas, Cuff-leak assessment, Sodium, potassium, bicarbonate, urea and creatinine, Bedside echocardiography.

Repeat monitoring: Readiness assessment and spontaneous breathing trial.

• Readiness for Liberation and Weaning from Mechanical Ventilation