The patient is at risk for iatrogenic withdrawal symptoms that may include diaphoresis, pupil vasodilation (not constriction), gastrointestinal distress, and fever (among others). Increased work of breathing – such as moderate suprasternal retractions – indicate the patient is not tolerating the removal of the breathing tube. Coughing episodes are not unexpected following extubation due to irritation of the oropharynx and vocal cords. Crackles in all lung fields are not necessarily indicative of a failed extubation but may be left over from being intubated.