Postextubation High-flow Therapy vs Noninvasive Ventilation in Obese or at High-risk Patients

Inclusion Criteria: 1. High-Risk Patients: Patients under mechanical ventilation for more than 24 hours considered at high risk according to the presence of more than 3 of the following risk factors: * \>65 years. * Cardiac failure as the primary indication of mechanical ventilation. * Moderate to severe chronic obstructive pulmonary disease. * APACHE II \>12 points the extubation day. * Body mass index \>30. * Inability to manage respiratory secretions. * Not simple weaning. * More than 1 comorbidity. * More than 7 days under mechanical ventilation. * Hypercapnia during the spontaneous breathing trial. * Airway patency problems. 2. Obese Intermediate Risk Patients: Patients under mechanical ventilation for more than 24 hours with a Body mass index \>30 and considered at intermediate risk according to the presence of less than 3 of the following risk factors: * \>65 years. * Cardiac failure as the primary indication of mechanical ventilation. * Moderate to severe chronic obstructive pulmonary disease. * APACHE II \>12 points the extubation day. * Inability to manage respiratory secretions. * Not simple weaning. * More than 1 comorbidity. * More than 7 days under mechanical ventilation. * Airway patency problems. Exclusion Criteria: * \<18 years. * Thacheotomized patients. * Contraindications for NIV (recent facial or cervical trauma/surgery, active gastro-intestinal bleeding, lack of cooperation). * Unscheduled extubation. * Do not reintubate orders. * No informed consent.