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 2 weeks.
- Receiving invasive mechanical ventilation via endotracheal tube for > 72 hours
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
- Expected not to survive the current ICU admission, or Do-Not-Reintubate order in place
- Previously randomized in this trial
- Underlying pre-existing condition with expected mortality less than 6-months.