Slow recruitment, interim analysis

Failure of extubation after mechanical ventilation is a frequent and deleterious issue. Main reasons for failure are hypoxemia, secretions retention, lung collapse and excessive work of breathing. Most of this issues can be partly counterbalanced by a device named "High flow conditioned oxygen therapy (HFCO)". Then, our hypothesis is that HFCO may reduce the incidence of respiratory failure after extubation in patients with high risk for failure.

Inclusion Criteria:

• Patients mechanically ventilated for > 48 hours and at least one of the following:
• >65 years
• cardiac failure as the primary indication of mechanical ventilation
• Chronic Obstructive Pulmonary Disease
• Severity score (APACHE II >12 points) the extubation day
• Body Mass Index >30
• inability to manage respiratory secretions
• 1 failed spontaneous breathing trial
• 1 comorbidity
• 7 days under mechanical ventilation

Exclusion Criteria:

• <18 years
• tracheotomized patients
• recent facial or cervical trauma/surgery
• active gastro-intestinal bleeding
• lack of cooperation
• patients with any failed spontaneous breathing trial because of hypercapnia development.