ICU tube removal showdown: suction vs. pressure

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion criteria Firstly, the decision to extubate must be made by the treating clinicians after having validated that the clinical criteria for weaning are met, namely: according to the international conference consensus on weaning , patients will be considered as ready for an initial SBT as soon as they meet all of the following criteria: * respiratory rate ≤35 breaths per minute, * adequate oxygenation defined as pulse oximetry (SpO2 ≥90%) with a fraction of inspired oxygen (FiO2) ≤0.4 or PaO2/FiO2 ≥150 mmHg with positive end-expiratory pressure ≤8 cm H2O, * hemodynamic stability with no need for vasopressors (or doses ≤0.3 μg/kg/min), * adequate cough, * patient awake with a Richmond Agitation-Sedation Scale between +1 and -2 Patients meeting any of the following criteria will be included in the EXSUPEEP trial: * ICU Hospitalization * Oro-tracheal intubation * Mechanical ventilation for more than 24 h * First extubation procedure during the stay in the including unit * Consent collected from a relative of the patient. Once it has been verified that the patient meets all the eligibility criteria listed above, the patient may be extubated after a successful SBT and after obtaining consent from the patient or family. Exclusion criteria Patients meeting any of the following criteria will be excluded from the EXSUPEEP trial: * Patients receiving ventilation via tracheostomy. * Patients with underlying chronic neuromuscular disease * Patients with severe head injury * Patients with a decision to withhold and/or withdraw life support * Patients not affiliated to or beneficiary of any social security scheme. * Person benefiting from enhanced protection, namely minors, pregnant or nursing women, persons deprived of their liberty by a judicial or administrative decision, persons residing in a healthcare or social establishment, adults under legal protection (safeguard of justice, guardianship or curatorship) * Inclusion in another research project that interferes with the outcomes of the present study * Weanability criteria not met within 72 hours following the signing of consent by the relatives. * Unsuccessful weaning test within 72 hours following the signing of consent by the relatives Patients with personal NIV or continuous positive airway pressure at home will be included if Pressure Support (PS) and/or PEEP used in the ICU unit are different from the usual settings at home. Regarding infection by SARS-CoV-2 or use of endotracheal tubes with subglottic suction, they do not constitute an exclusion criterion.