| F | Are fluids optimized? (May need to diurese) Evaluate BNP |
| A | Is there an airway problem? Anemia? Adrenal Insufficiency? An Acid-base imbalance? Does the patient need afterload reduction? |
| I | Is there an infection? (Observe for and limit possible sources) |
| L | Does the cardiac load or pulmonary load need to be optimized? |
| U | Is the patient under the influence of sedation or analgesia? (Attempt reduction, manage pain, anxiety and sleep deprivation) |
| R | Would repositioning help? (Elevate HOB, if not contraindicated) |
| E | Is nutrition adequate? (Eating) |
| T | Are there medication toxicities or a thyroid problem? |
| O | Is the oxygen (FiO2) optimized, particularly prior to extubation? |
| W | Is the patient wheezing?—Administer nebs: Decrease airway resistance—verify patent ET tube |
| E | Are the electrolytes (K, PO4, Mg, Ca) all within normal limits? (Correct as able) |
| A | Does the patient need some anti-inflammatory drugs? (Consider steroids 4–6 hours prior to extubation, particularly if failed cuff leak test) |
| N | Is the patient's neuro status appropriate? Awake enough to protect the airway? Muscle strength sufficient? |