The timing of extubation in patients with mechanical ventilation is confronted by intensivists and physicians in the United States on a daily basis. Theoretically, earlier extubation has the potential to prevent ventilator-associated complications and decrease the length of intensive care unit (ICU) and hospital stays. However, overnight extubation may be riskier, in part because fewer and less experienced physicians, nurses, and respiratory therapists are available. Although the clinically important question of when to extubate arises daily in the ICU, current research on the optimal timing for extubation is insufficient.