Interventions to Improve Rate of Successful Extubation in Preterm Infants

MedicalResearch.com Interview with:
Kristin N. Ferguson, BSc

The Royal Women’s Hospital and
Deakin University
Melbourne, Victoria, Australia

MedicalResearch.com: What is the background for this study?

Response: Weaning preterm infants from mechanical ventilation, thereby minimising the risks of having an endotracheal tube in situ which may further damage their fragile lungs, is something all neonatal clinicians are keen to do. We provide clinicians with a straightforward list of safe and effective strategies to help them in this task, as well as pointing out some treatments to either avoid or use with caution.

MedicalResearch.com: What are the main findings?

Response: Our key findings suggest that infants should be extubated to non-invasive respiratory support, with Nasal Intermittent Positive Pressure Ventilation (NIPPV) and Continuous Positive Airway Pressure (CPAP) having the greatest evidence-base.

Caffeine was also found to assist in extubation success, and given its long-term safety should be considered for routine use.

Corticosteroids should be used judiciously, weighing up the competing risks of bronchopulmonary dysplasia and neurodevelopmental harm. Doxapram was not effective in facilitating extubation. Although chest physiotherapy significantly improved extubation success, the studies assessed were undertaken more than 10 years ago and questions have been raised regarding its safety.

MedicalResearch.com: What should readers take away from your report?

Response: Clinicians should use this report as an evidence-based summary, which they can use to guide management applicable to their clinical context and resource availability.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: A key limitation of this study was the heterogeneity between included studies. Following this study, we encourage the neonatal research community to develop a standard definition of extubation success/failure in order to facilitate better synthesis of the evidence in the future.

Future research questions should focus specifically on extremely preterm infants.

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Citation:

Ferguson KN, Roberts CT, Manley BJ, Davis PG. Interventions to Improve Rates of Successful Extubation in Preterm Infants A Systematic Review and Meta-analysis. JAMA Pediatr. Published online December 05, 2016. doi:10.1001/jamapediatrics.2016.3015

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