All patients will be followed until death or hospital discharge. We will record the vital status of all patients at 90 days and hospital discharge, whichever occurs first. At day 60 patients remaining on the ventilator will be deemed ventilator dependent. Randomized patients will be considered successfully extubated when they remain off positive pressure ventilation (invasive or non-invasive ventilation) for 48 consecutive hours. If patients are re-intubated within 48 hrs following extubation, they will be followed until they achieve one of the aforementioned outcomes. Patients discharged from the ICU and requiring readmission and re-initiation of mechanical ventilation (invasive or noninvasive) will be treated according to usual practice and will not be randomized on a second occasion to this study.