Facilitating extubation in neonates

Prolonged endotracheal intubation is associated with biotrauma and development of chronic lung disease. Measures to facilitate per-extubation can decrease duration of invasive ventilation.

Cochrane library and Pubmed were searched to retrieve studies investigating measures to facilitate extubation.

Use of synchronized intermittent mandatory ventilation or assist-control ventilation modes is associated with faster weaning. Post-extubation support with nasal continuous positive airway pressure (CPAP) and methylxanthines reduces chances of extubation failure in preterm neonates. Nasal intermittent mandatory ventilation can further improve the probability of successful extubation. Routine use of inhaled or systemic corticosteroids, chest physiotherapy and nebulized epinephrine is not indicated. Spontaneous breath trial with brief period of endotracheal CPAP can help the clinicians in deciding readiness of extubation.

Evidence-based approach to facilitate extubation can reduce chances of reintubation and duration of invasive ventilation.