Optimising success of neonatal extubation: Respiratory support

Abstract

In this review, we examine lung physiology before, during and after neonatal extubation and propose a three-phase model for the extubation procedure. We perform meta-analyses to compare different modes of non-invasive respiratory support after neonatal extubation and based on the findings, the following clinical recommendations are made:

• 1)

  Continuous positive airway pressure support (CPAP) remains standard of care for most extubations.

• 2)

  For high-risk infants <28 weeks' gestation or infants with expected cardiorespiratory instability, either NIPPV or nHFOV may be used as post-extubation respiratory support. Synchronized, ventilator-generated NIPPV may be more effective than alternative modes. The use of nHFOV after extubation seems to confer the largest benefit but clinical experience is limited in most centres.

• 3)

  If backup CPAP is available, high-flow therapy may be preferred for infants ≥28 weeks with a low fraction of inspired oxygen.