Abstract

• 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.