A Prospective Trial of Elective Extubation in Brain Injured Patients.

Inclusion Criteria: 1. Resolution or improvement of any pulmonary process requiring mechanical ventilation. 2. Adequate gas exchange. 3. Adequate ventilation. 4. Respiratory rate to tidal volume ratio \<105. 5. Core body temperature \< 38 degrees celsius. 6. Hemoglobin \> 8 grams per deciliter. 7. No sedative medications for 2 hours. Neurological requirements included: 1. GCS ≤ 8. 2. Intracranial pressure (ICP) \< 15 cm of water and a cerebral perfusion pressure (CPP) \> 60 mm Hg for patients with intracranial pressure monitors. Exclusion Criteria: 1. Age \< 18 years. 2. Lack of informed consent by the patients' surrogate. 3. Dependence on mechanical ventilation for at least two weeks prior to enrollment. 4. Patients with tracheostomies. 5. Intubation instituted for therapeutic hyperventilation. 6. Planned surgical or radiological intervention within the next 72 hours. 7. Anticipated neurological or medically worsening conditions (i.e develop cerebral edema or vasospasm). 8. Patients intubated for airway preservation due to airway edema (cervical neck injuries or surgery) as opposed to airway protection.