The Sixth International Consensus Conference on Intensive Care Medicine, organized by the European Respiratory Society (ERS), the American Thoracic Society (ATS), the European Society of Intensive Care Medicine (ESICM), the Society of Critical Care Medicine (SCCM), and the Société de Réanimation de Langue Française (SRLF), addressed the process of weaning patients from mechanical ventilation. The conference, held in April 2005, aimed to provide recommendations for managing the weaning process, which involves liberating patients from mechanical support and the endotracheal tube. Key questions included the epidemiology of weaning problems, the pathophysiology of weaning failure, the usual process of initial weaning, the role of different ventilator modes in difficult weaning, and the management of patients with prolonged weaning failure. The main recommendations were: 1. Patients should be categorized into three groups based on the difficulty and duration of the weaning process. 2. Weaning should be considered as early as possible. 3. A spontaneous breathing trial (SBT) is the primary diagnostic test to determine if patients can be successfully extubated. 4. The initial SBT should last 30 minutes and consist of either T-tube breathing or low levels of pressure support (5-8 cmH2O in adults, ≤10 cmH2O in pediatric patients) with or without 5 cmH2O PEEP. 5. Pressure support or assist-control ventilation modes should be favored in patients who fail an initial trial. 6. Noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure. The conference also discussed the pathophysiology of weaning failure, including respiratory load, cardiac load, neuromuscular competence, critical illness neuromuscular abnormalities (CINMA), neuropsychological factors, and metabolic and endocrine disorders. It emphasized the importance of early assessment of readiness for weaning and the use of weaning protocols to standardize the process. The consensus statement was approved by the board of administrators of the five organizing societies and submitted for peer review. Further research is needed to evaluate the effectiveness of noninvasive ventilation, the role of CINMA, and the impact of various ventilator modes on weaning outcomes.The Sixth International Consensus Conference on Intensive Care Medicine, organized by the European Respiratory Society (ERS), the American Thoracic Society (ATS), the European Society of Intensive Care Medicine (ESICM), the Society of Critical Care Medicine (SCCM), and the Société de Réanimation de Langue Française (SRLF), addressed the process of weaning patients from mechanical ventilation. The conference, held in April 2005, aimed to provide recommendations for managing the weaning process, which involves liberating patients from mechanical support and the endotracheal tube. Key questions included the epidemiology of weaning problems, the pathophysiology of weaning failure, the usual process of initial weaning, the role of different ventilator modes in difficult weaning, and the management of patients with prolonged weaning failure. The main recommendations were: 1. Patients should be categorized into three groups based on the difficulty and duration of the weaning process. 2. Weaning should be considered as early as possible. 3. A spontaneous breathing trial (SBT) is the primary diagnostic test to determine if patients can be successfully extubated. 4. The initial SBT should last 30 minutes and consist of either T-tube breathing or low levels of pressure support (5-8 cmH2O in adults, ≤10 cmH2O in pediatric patients) with or without 5 cmH2O PEEP. 5. Pressure support or assist-control ventilation modes should be favored in patients who fail an initial trial. 6. Noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure. The conference also discussed the pathophysiology of weaning failure, including respiratory load, cardiac load, neuromuscular competence, critical illness neuromuscular abnormalities (CINMA), neuropsychological factors, and metabolic and endocrine disorders. It emphasized the importance of early assessment of readiness for weaning and the use of weaning protocols to standardize the process. The consensus statement was approved by the board of administrators of the five organizing societies and submitted for peer review. Further research is needed to evaluate the effectiveness of noninvasive ventilation, the role of CINMA, and the impact of various ventilator modes on weaning outcomes.