Brain-injured Patients Extubation Readiness Study

This study investigates the best way to decide when to remove a breathing tube (extubate) from brain-injured patients in the ICU who are regaining some consciousness but are not yet fully awake. After a stroke, brain injury, or cardiac arrest, patients often need a mechanical ventilator to breathe for them, and deciding when it is safe to remove the breathing tube is difficult — remove it too early and the patient may fail, too late and complications can arise. This study looks at developing better criteria and protocols for safe extubation in these challenging patients. Brain-injured patients are different from other ICU patients when it comes to extubation because they may be unable to swallow or protect their airway even when their lungs are ready. This study carefully documents what happens to patients in this situation and aims to identify the best predictors of successful extubation. You may be eligible if: - You are aged 18 to 75 years - You have an acute brain injury (stroke, traumatic brain injury, post-cardiac arrest, or brain tumour) requiring ICU admission and mechanical ventilation - You have been on the ventilator for more than 48 hours - You are neurologically stable with minimal sedation - This would be your first extubation attempt - You passed a spontaneous breathing trial You may NOT be eligible if: - Your brain injury is in the posterior cranial fossa - You have a spinal cord injury, uncontrolled seizures, or active CNS infection - You have a chronic respiratory condition (COPD, sleep apnoea requiring CPAP) - You are pregnant or breastfeeding - You have a care limitation plan (e.g., palliation) Talk to your doctor to see if this trial is right for you.