Clinical Research Directory

inclusion criteria: * Patients intubated for 48 h or more * Patients who tolerated a 120-min spontaneous breathing trial after recovery from their acute disease with no signs of respiratory failure * Patients at high risk for respiratory after extubation were enrolled if they had at least two of the following risk factors for respiratory failure after extubation: * age older than 65 years * Chronic obstructive pulmonary disease, * heart failure as the cause for intubation * An Acute Physiology and Chronic Health Evaluation (APACHE)-II score greater than 12 on the day of extubation. exclusion criteria: * Age younger than 18 years * Head trauma or surgery * Recent gastric or oesophageal surgery * Active upper gastrointestinal bleeding * Excessive amount of respiratory secretions * Poor cooperation * Decision to limit life-supporting treatments in the ICU * Tracheostomy or other upper airway disorders * Lack of collaboration * Do not resuscitate order or any decision to limit therapeutic effort in the ICU.