From a good idea to the best practice!

We congratulate the authors on their interest in early extubation following lung transplantation, highlighted in their article recently published in the last International Society for Heart and Lung Transplantation journal. 1 Sage A.T. Peel J. Valero J. et al. Time to extubation for lung transplant recipients represents a pragmatic endpoint to guide the development of prognostic tests. J Heart Lung Transplant. 2023; Abstract Full Text Full Text PDF Scopus (2) Google Scholar We share the authors' hypothesis about the predictive nature of early extubation and the importance of studying its impact on patient outcomes. Westerlind et al were the first to propose early extubation to reduce complications caused by mechanical ventilation after lung transplantation. 2 Westerlind A. Nilsson F. Ricksten S.E. The use of continuous positive airway pressure by face mask and thoracic epidural analgesia after lung transplantation. Gothenburg Lung Transplant Group. J Cardiothorac Vasc Anesth. 1999; 13: 249-252 Abstract Full Text PDF PubMed Scopus (22) Google Scholar Myles supported this strategy when he detailed five points to achieve early extubation: the use of short-acting drugs combined with effective analgesia, such as thoracic epidural analgesia; the avoidance of excessive fluid support; the maintenance of normothermia; and the application of systematic postoperative noninvasive ventilation. 3 Myles P.S. Early extubation after lung transplantation. J Cardiothorac Vasc Anesth. 1999; 13: 247-248 Abstract Full Text PDF PubMed Scopus (10) Google Scholar Historically, few teams followed his recommendations. 4 Hansen L.N. Ravn J.B. Yndgaard S. Early extubation after single-lung transplantation: analysis of the first 106 cases. J Cardiothorac Vasc Anesth. 2003; 17: 36-39 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar , 5 Rocca G.D. Coccia C. Costa G.M. et al. Is very early extubation after lung transplantation feasible?. J Cardiothorac Vasc Anesth. 2003; 17: 29-35 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar , 6 Augoustides J.G. Watcha S.M. Pochettino A. Jobes D.R. Early tracheal extubation in adults undergoing single-lung transplantation for chronic obstructive pulmonary disease: pilot evaluation of perioperative outcome. Interact Cardiovasc Thorac Surg. 2008; 7: 755-758 Crossref PubMed Scopus (15) Google Scholar , 7 Felten M.L. Moyer J.D. Dreyfus J.F. et al. Immediate postoperative extubation in bilateral lung transplantation: predictive factors and outcomes. Br J Anaesth. 2016; 116: 847-854 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar , 8 Assenzo V. Assenzo C. Filippo R. et al. The feasibility of extubation in the operating room after bilateral lung transplantation in adult emphysema patients: an observational retrospective study. Eur J Cardio-Thorac Surg. 2018; 54: 1128-1133 Crossref PubMed Scopus (12) Google Scholar