AI Article Synopsis
- - The chapter examines medications used for managing newborns in the critical peri-extubation period, aiming to lower the chances of needing re-intubation and prolonging mechanical ventilation.
- - Caffeine, a methylxanthine, is highlighted as the most effective drug for improving extubation outcomes in preterm infants, while other drugs like doxapram, steroids, and salbutamol are also discussed but lack strong evidence.
- - The text emphasizes that most term infants do not require drug assistance for extubation and suggests that future research should explore caffeine's role in late preterm infants and other medications for complications post-extubation.
Article Abstract
This chapter focuses on the pharmacological management of newborn infants in the peri-extubation period to reduce the risk of re-intubation and prolonged mechanical ventilation. Drugs used to promote respiratory drive, reduce the risk of apnoea, reduce lung inflammation and avoid bronchospasm are critically assessed. When available, Cochrane reviews and randomised trials are used as the primary sources of evidence. Methylxanthines, particularly caffeine, are well studied and there is accumulating evidence to guide clinicians on the timing and dosage that may be used. Efficacy and safety for doxapram, steroids, adrenaline and salbutamol are summarised. Management of term infants, extubation following surgery, accidental and complicated extubation and the use of cuffed endotracheal tubes are presented. Overall, caffeine is the only drug with a substantial evidence base, proven to increase the likelihood of successful extubation in preterm infants; no drugs are needed to facilitate extubation in most term infants. Future studies might further define the role of caffeine in late preterm infants and evaluate medications for post-extubation stridor, bronchospasm or apnoea not responsive to methylxanthines.
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| http://dx.doi.org/10.1016/j.siny.2023.101490 | DOI Listing |
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