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Intubation and extubation of ventilated patients are not risk free procedures in the Intensive Care Unit (ICU) and can be associated with morbidity and mortality. Intubation in the ICU is frequently required in emergency situations for patients with an unstable cardiovascular system who may be hypoxicaemic [1–3]. Under these circumstances, it is a high-risk procedure with life threatening complications (20–50%) such as hypotension and respiratory failure [2]. Technical problems can also give rise to complications. Generally three unsuccessful intubations [4], or two unsuccessful attempts at laryngoscopy are needed to justify the description difficult airway. These can make up 10–20% of intubations in the ICU and are associated with an increase in morbidity [2]. Several new techniques such as videolaryngoscopy have been developed for difficult airway management but contrary to operating room practice, integrating these into ICU algorithms is not well established. Another period of risk is extubation, which fails in approximately 10% and is associated with a poor prognosis [5, 6]. Extubation follows the successful weaning of patients from mechanical ventilation [7–9], but sometimes the re-establishment of spontaneous breathing is only possible with the tube in situ. An extubation failure is defined as the need for reintubation within 48 h of tube removal [7, 10] and the most recent consensus on weaning defined success as the absence of mechanical assistance for 48h after extubation. There is a need to incorporate into these definitions the development of non-invasive ventilation (NIV) after extubation. Indeed, NIV can be used as a weaning aid …