In this review, we examine lung physiology before, during and after neonatal extubation and propose a three-phase model for the extubation procedure.
We perform meta-analyses to compare different modes of non-invasive respiratory support after neonatal extubation and based on the findings, the following clinical recommendations are made:
- Continuous positive airway pressure support (CPAP) remains standard of care for most extubations.
- For high-risk infants <28 weeks' gestation or infants with expected cardiorespiratory instability, either NIPPV or nHFOV may be used as post-extubation respiratory support.
Synchronized, ventilator-generated NIPPV may be more effective than alternative modes. The use of nHFOV after extubation seems to confer the largest benefit but clinical experience is limited in most centres
- If backup CPAP is available, high-flow therapy may be preferred for infants ≥28 weeks with a low fraction of inspired oxygen.