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Following critical illness requiring intubation, a key step in recovery is liberation from mechanical ventilation. There is a risk during this process of developing postextubation acute respiratory failure (PRF) leading to reintubation. The WIN IN WEAN multicentre randomised controlled trial (Rouby et al. JAMA 2025 doi:10.1001/jama.2024.15815) used a lung ultrasound score (LUS) to characterise the risk of PRF. They identified high risk patients (lung ultrasound score>14) and randomised to receiving intermittent HFNO and NIV (intervention) or conventional oxygen (control) on extubation in the hope of preventing PRF.