More than just a screen to liberate from mechanical ventilation: treat to keep extubated?

As a life-support modality, mechanical ventilation (MV) has been utilized to support ventilation and oxygenation for patients with respiratory compromise for over five decades. While MV saves lives, it is associated with considerable and relevant clinical complications such as ventilator-induced lung injury (VILI), ventilator-associated events (VAE), and ventilator-induced diaphragmatic dysfunction (VIDD) (1,2). Thus, efforts to liberate patients from MV as early as possible are common and play a key role in clinical outcomes (2,3). The task to liberate a patient from MV is complicated, as premature extubation has been reported to be harmful. In fact, the mortality for patients who failed initial extubation and required subsequent reintubation has been reported to be 4–9 times higher than those successfully extubated (4-7). In contrast, delayed extubation unnecessarily extends the duration of MV, increasing the likelihood of MV complications. Therefore, identifying the optimal time to liberate patients from MV is crucial.