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Difficult extubation in low birth weight infants
  1. Anne Greenough (anne.greenough{at}
  1. Kings College London, United Kingdom
    1. Michael Prendergast (michael.prendergast{at}
    1. King's College London, United Kingdom


      • 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.

      • extubation
      • low birthweight
      • mechanical ventilation
      • prematurity
      • weaning

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