[Difficult extubation]

Optimal timing of extubation following intubation substantially impacts on the prognosis of intensive care unit (ICU) patients whereby both early extubation with the risk of reintubation and delayed extubation with prolongation of mechanical ventilation need to be avoided. In most cases extubation is easy; in some cases, however, extubation may be extremely difficult or even impossible with two major reasons being responsible for this: firstly, laryngeal edema, where the cuff leak test and steroid treatment are well established procedures aimed at diagnosing and treating potential laryngeal complications and secondly, the presence of (chronic) respiratory failure despite sufficient treatment of acute respiratory failure. This can result in post-extubation failure following extubation or weaning failure and noninvasive ventilation has been increasingly used in both scenarios. Currently, specialised weaning centres are being established and certified in Germany aimed at managing the complex tasks for patients with prolonged weaning.