Mechanical ventilation (MV) causes lung injury through different mechanisms including volutrauma, barotrauma, rheotrauma, atelectotrauma and biotrauma.

The resulting ventilator induced lung injury is the major cause of bronchopulmonary dysplasia (BPD), which can lead to multiple respiratory problems in infancy and thereafter.

Consequently, as a possible means to prevent lung injury and BPD, non-invasive ventilation (NIV) has gained ground in modern neonatology practise. Nevertheless, due to lung immaturity, weak respiratory drive and surfactant deficiency, up to 82% of the extremely premature infants still require MV to maintain oxygenation and ventilation.

In these infants, early extubation decreases BPD and the combined  BPD/Death outcome.

However, premature extubation and the need to reintubate within 48 h was shown to significantly increased the combined risk of death/BPD in preterm infants.6 Notably, about one fourth of our babies had extubation failure.