Objective: To identify risk factors associated with failed extubation in adult patients hospitalized in an intensive care unit of a level III hospital of Cali, during the period of June 2012 to June 2014. Materials and methods: Case-control study of adult patients requiring mechanical ventilation greater than 48 hours. Patients who failed extubation (cases) were compared with patients who were successfully extubated (control), age, oxygenation index PaO2/FIO2, fluid balance, hemoglobin, days of mechanical ventilation, type of weaning and mortality were analyzed. Results: The study population consisted of 130 patients, of whom 26 (20%) had failed extubation (cases). There were no significant differences between the groups regarding age, gender, diagnosis and comorbidities. Prolonged weaning was the only factor associated with failed extubation 3,17 (95% ci 1,01-9,90). No statistically significant relationship between PaO2/FIO2, Hb, fluid balance or Apache II scale and the occurrence of failed extubation were observed. Mortality was higher in the case group (23,1% vs 2,9%) with an or 10,1 (95% ci 1,9-65,8). Conclusions: Prolonged weaning was the only factor associated with extubation failure. The risk of dying from a patient with a failed extubation was 10 times the risk of a patient with a successful extubation.