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.