*2.3.2 Weaning and extubation*

Airway securing device in critically ill patients might be temporary for bridging a reversible and treatable medical disorder or permanent for irreversible and long-term pathology that demanding it. The former, long-term medical conditions, alternative tracheostomy have to be considered with a debate of its timing, On the other hand in reversible and corrected medical conditions; weaning and extubation must be considered in due time to avoid complications of prolonged ETT. Critically ill patients' intubation is challenging and extubation does too.

Tracheostomy might be an alternative of ETT as a definitive airway in critically ill patients in incidence of 7–19% [50] while extubation is the plan once the circumstances permit. Extubation is an elective procedure and mandates careful evaluation, preparation with the target of maintenance of oxygenation and standby intubation plan if extubation failure takes place.

DAS incorporated extubation guidelines in anesthesia practice and could derive that in ICU and summarized in four steps; [51].

## **Step 1: Plan for extubation:**


iii.A difficult airway trolley equipment and monitors should be immediately available for use.
