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Noninvasive Ventilation Strategies to Prevent Post-extubation Failure: Neonatology Perspective

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Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care

Abstract

Respiratory failure is the most common problem encountered in the neonatal intensive care unit (NICU) [1]. Nearly two-thirds of infants born less than 29 weeks’ gestation require endotracheal intubation and mechanical ventilation (MV) while admitted to the NICU [1]. Although MV is often lifesaving, it is associated with multiple short- and long-term sequelae, including subglottic injury, infection, bronchopulmonary dysplasia (BPD), and neurocognitive impairment [2]. As a consequence, clinicians try to avoid or minimize the duration of MV and extubate infants as early as possible. Following extubation, application of a continuous distending pressure to the airways helps prevent alveolar collapse and maintain gas exchange [3]. Although noninvasive respiratory support has become routine for post-extubation management in preterm infants, optimal strategies to prevent extubation failure have not been clearly defined. This chapter aims to review the definitions of post-extubation failure and describe the available equipment and techniques for noninvasive post-extubation respiratory support in preterm infants.

Funding Support

Georg M. Schmölzer is a recipient and a Heart and Stroke Foundation Canada Scholarship/University of Alberta Professorship of Neonatal Resuscitation.

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Abbreviations

BPD:

Bronchopulmonary dysplasia

BW:

Birth weight

CPAP:

Continuous positive airway pressure

FRC:

Functional residual capacity

HFNC:

High-flow nasal cannula

MV:

Mechanical ventilation

NAVA:

Neurally adjusted ventilator assist

NICU:

Neonatal intensive care unit

NIPPV:

Noninvasive positive pressure ventilation

RCT:

Randomized controlled trial

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Correspondence to Erik A. Jensen MD .

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Jensen, E.A., Schmölzer, G.M. (2016). Noninvasive Ventilation Strategies to Prevent Post-extubation Failure: Neonatology Perspective. In: Esquinas, A. (eds) Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-04259-6_49

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  • DOI: https://doi.org/10.1007/978-3-319-04259-6_49

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-04258-9

  • Online ISBN: 978-3-319-04259-6

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