• Randomised trials have demonstrated that ventilation techniques which support every spontaneous breath are the most efficacious weaning modes.
• Nasal CPAP post extubation reduces the likelihood of incidents leading to the need for reintubation in VLBW infants; further work is needed to determine if there are advantages of particular delivery techniques.
• Both methylxanthines and dexamethasone facilitate weaning and extubation; dexamethasone given systemically is effective even when given 21 days or more after birth; the efficacy of low dose dexamethasone merits further investigation.
• Assessments of the efficacy of respiratory efforts and hence the balance of respiratory drive, muscle performance and respiratory load appear to best predict weaning and extubation success.
• Essential to the success of weaning and extubation is dedicated staff, whether this will be facilitated by computerised decision making tools requires testing.
• Whether adequate nutrition during mechanical ventilation influences the success of extubation merits investigation.
• The above approaches are not mutually exclusive and those indicated by this review as appropriately evidence based should be considered by practitioners for current use to reduce difficult/unsuccessful extubation.
- low birthweight
- mechanical ventilation
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