The NEUROlogically-impaired Extubation Timing Trial

Inclusion Criteria: * Age \> 16 years * Acute brain injury (subarachnoid hemorrhage, ischemic stroke, spontaneous intracerebral hemorrhage, seizure, traumatic brain injury, brain tumor, global cerebral anoxia/cardiac arrest, meningitis/encephalitis/cerebral abscess) that occurred within the previous 4 weeks. * Receiving invasive mechanical ventilation via endotracheal tube for \> 72 hours * Glasgow Coma Scale motor score 3 to 6 with improvement or no change from previous day * passed spontaneous breathing trial (SBT) Exclusion Criteria: * Previous extubation during this ICU admission * Quadriplegic * Neuromuscular disease that will result in prolong need for mechanical ventilation, including but not limited to Guillain-Barre syndrome, cervical spinal cord injury, advanced multiple sclerosis * Do-Not-Reintubate order in place * Previously randomized in this trial * Underlying pre-existing condition with expected mortality less than 6-months. * Anticipated/scheduled for surgical procedures within 48 hours * C-spine not yet cleared for activity as tolerated (cleared for activity as tolerated while wearing hard collar is acceptable) * Currently known or suspected to have an difficult airway * Absence of an endotracheal tube cuff leak, if checked * Absence of spontaneous or induced cough * Current enrolment in an RCT that precludes NEURO-ETT co-enrollment