{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T12:49:47Z","timestamp":1785761387984,"version":"3.56.0"},"reference-count":109,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Efforts to liberate patients from invasive mechanical ventilation (MV) begin when the underlying cause of acute hypoxemic respiratory failure (AHRF) or adult respiratory distress syndrome (ARDS) that led to use of invasive ventilation has resolved or improved and patients can initiate spontaneous breaths. In preparation for liberation, clinicians transition patients to spontaneous modes of ventilation as soon as possible while ensuring that patients\u2019 respiratory effort is not insufficient or excessive during weaning attempts. Concurrently, clinicians aim to minimize the effects of sedative and analgesic agents, screen daily to identify patients who are ready to undergo a spontaneous breathing trial (SBT), and conduct SBTs to help assess patients\u2019 readiness for extubation. Extubation failure is rarely the consequence of a single physiological abnormality. Rather, it reflects the interaction of multiple mechanisms that often coexist, including an imbalance between respiratory system load and capacity, ineffective cough, and secretion burden among others. For these reasons, single weaning parameters and SBTs may fail to identify some patients who are at risk for extubation failure. Conversely, indices and scores that combine two or more parameters and newer techniques may provide mechanistic insights into the pathways that lead to extubation failure, help to characterize \u2018at-risk\u2019 phenotypes, and identify patients who may benefit from closer monitoring, targeted therapeutic strategies, and\/or early application of noninvasive respiratory support strategies such as high-flow nasal cannula (HFNC) and bilevel noninvasive positive pressure ventilation (NIV).<\/jats:p>","DOI":"10.3390\/jcm15156019","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T11:50:21Z","timestamp":1785757821000},"page":"6019","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Liberation from Mechanical Ventilation in Acute Hypoxemic Respiratory Failure or Adult Respiratory Distress Syndrome: A Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9967-5424","authenticated-orcid":false,"given":"Karen E. A.","family":"Burns","sequence":"first","affiliation":[{"name":"Department of Medicine, Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON M5G 1V7, Canada"},{"name":"Department of Medicine, Division of Critical Care, Unity Health Toronto\u2014St. Michael\u2019s Hospital, Toronto, ON M5B 1W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen J.","family":"Bosma","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, The University of Western Ontario, London, ON N6A 3K7, Canada"},{"name":"Division of Critical Care, London Health Sciences Centre, London, ON N6A 5A5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno L.","family":"Ferreyro","sequence":"additional","affiliation":[{"name":"Department of Medicine, Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON M5G 1V7, Canada"},{"name":"Department of Medicine, Sinai Health System, University of Toronto, Toronto, ON M5G 1V7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipayan","family":"Chaudhuri","sequence":"additional","affiliation":[{"name":"Department of Critical Care, Division of Critical Care Medicine, Markham-Stoufville Hospital, Markham, ON L3P 7P3, Canada"},{"name":"Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON L8S 4L8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J. E.","family":"Seely","sequence":"additional","affiliation":[{"name":"Acute Care Research, Ottawa Hospital Research Institute, The University of Ottawa, Ottawa, ON K1N 6N5, Canada"},{"name":"Department of Critical Care, Ottawa Hospital\u2014General Campus, Ottawa, ON K1H 8L6, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Ouellette","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI 48202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1378\/chest.106.4.1188","article-title":"Modes of mechanical ventilation and weaning: A national survey of Spanish hospitals","volume":"106","author":"Esteban","year":"1994","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1164\/ajrccm\/137.6.1463","article-title":"Complications of acute respiratory failure","volume":"137","author":"Pingleton","year":"1988","journal-title":"Am. 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