Inclusion Criteria- Age > 16 years
- Acute brain injury (subarachnoid hemorrhage, ischemic stroke, spontaneous intracerebral hemorrhage, seizure, traumatic brain injury, brain tumor, global cerebral anoxia/cardiac arrest, meningitis/encephalitis/cerebral abscess) that occurred within the previous 4 weeks.
- Receiving invasive mechanical ventilation via endotracheal tube for > 72 hours
- Glasgow Coma Scale motor score 3 to 6 with improvement or no change from previous day
- passed spontaneous breathing trial (SBT)
Exclusion Criteria- Previous extubation during this ICU admission
- Neuromuscular disease that will result in prolong need for mechanical ventilation, including but not limited to Guillain-Barre syndrome, cervical spinal cord injury, advanced multiple sclerosis
- Do-Not-Reintubate order in place
- Previously randomized in this trial
- Underlying pre-existing condition with expected mortality less than 6-months.
- Anticipated/scheduled for surgical procedures within 48 hours
- C-spine not yet cleared for activity as tolerated (cleared for activity as tolerated while wearing hard collar is acceptable)
- Currently known or suspected to have an difficult airway
- Absence of an endotracheal tube cuff leak, if checked
- Absence of spontaneous or induced cough
- Current enrolment in an RCT that precludes NEURO-ETT co-enrollment