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 While the decision to extubate is partly driven by objective data, it also relies upon clinical judgment.

 Patients should have stable vital signs, an SpO2 of at least 90% or an FiO2 of 40% or less, PaCO2 <50 mmHg unless there is known chronic CO2 retention, adequate tidal volumes on minimal pressure support, intact airway reflexes, and baseline mental status.

 One should also consider the specific situation such as difficulty of intubation, barriers to reintubation (e.g. jaw wired shut after maxillofacial surgery, significant airway edema), fluid balance, and acid–base balance.

 If there is any question of airway patency, one may consider performing a leak test (deflating the ETT cuff and listening for air movement around the ETT and observing a decrease in tidal volume) or extubating over an ETT exchanger with a backup ETT available in case reintubation becomes necessary.

 Patients with baseline pulmonary dysfunction may benefit from being extubated to BIPAP or HFNC.