Article Text

Download PDFPDF
Decision to extubate extremely preterm infants: art, science or gamble?
  1. Wissam Shalish1,
  2. Martin Keszler2,
  3. Peter G Davis3,
  4. Guilherme M Sant’Anna1
  1. 1 Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
  2. 2 Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island, USA
  3. 3 Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Wissam Shalish, Pediatrics, McGill University Health Centre, Montreal, QC H4A 3J1, Canada; wissam.shalish{at}


In the modern era of neonatology, mechanical ventilation has been restricted to a smaller and more immature population of extremely preterm infants. Given the adverse outcomes associated with mechanical ventilation, every effort is made to extubate these infants as early as possible. However, the scientific basis for determining extubation readiness remains imprecise and primarily guided by clinical judgement, which is highly variable and subjective. In the absence of accurate tools to assess extubation readiness, many infants fail their extubation attempt and require reintubation, which also increases complications. Recent advances in the field have led to unravelling some of the complexities surrounding extubation in this population. This review aims to synthesise the available knowledge and provide a more evidence-based approach towards the reporting of extubation outcomes and assessment of extubation readiness in extremely preterm infants.

  • neonatology
  • physiology

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

View Full Text


  • Contributors WS and GMSA conceptualised and designed the study, drafted the initial manuscript and reviewed and revised the manuscript. MK and PGD critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.