EXtubation With SUctioning or With Positive End-Expiratory Pressure in Intensive Care Unit

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 * …