Related Experiment Video
Updated: Aug 26, 2026
Inspiratory Muscle Training as an Adjunct to the Treatment of Weaning Failure in Critically Ill Patients: A Practical Guide
Published on: January 30, 2026
What interventions facilitate weaning from the ventilator? A review of the evidence from systematic reviews
1Department of Child Health, Queens, University of Belfast and Regional Neonatal Unit, Royal Maternity Hospital, Belfast, Northern Ireland. h.halliday@qub.ac.uk
Insights
Nasal CPAP and NIPPV help wean preterm infants off mechanical ventilation, reducing risks like chronic lung disease. Methylxanthines also aid extubation, especially in very low birth weight infants.
Area of Science:
- Neonatal care
- Pediatric respiratory medicine
- Critical care
Background:
- Mechanical ventilation is crucial for preterm infants but prolonged use increases risks of subglottic injury and chronic lung disease (CLD).
- Facilitating earlier extubation is key to reducing these adverse effects.
- Various interventions have been explored to support timely discontinuation of mechanical ventilation.
Purpose of the Study:
- To systematically review randomized controlled trials on interventions aimed at facilitating extubation in preterm infants.
- To evaluate the effectiveness of different methods in reducing post-extubation complications such as atelectasis and failure.
Main Methods:
- A comprehensive search of the Cochrane Library was conducted for systematic reviews of randomized controlled trials.
- Interventions assessed included nasal continuous positive airway pressure (CPAP), nasal intermittent positive pressure ventilation (NIPPV), chest physiotherapy, intravenous dexamethasone, and methylxanthine treatment.
- Outcomes were analyzed using numbers needed to treat (NNT) with 95% confidence intervals (CI).
Main Results:
- Nasal CPAP reduced extubation failure (NNT 6) and CLD at 28 days (NNT 6).
- Nasal intermittent positive pressure ventilation (NIPPV) was more effective than CPAP in preventing extubation failure (NNT 3).
- Chest physiotherapy decreased re-intubation rates (NNT 6) but did not reduce atelectasis; intravenous dexamethasone also reduced re-intubation (NNT 6) but has adverse effects. Methylxanthines improved extubation success (NNT 4), particularly in infants <1000g and <7 days old (NNT 2).
Conclusions:
- Nasal CPAP, NIPPV, and methylxanthines are evidence-based for facilitating extubation in preterm infants.
- Nasal CPAP and NIPPV are recommended for routine use.
- Chest physiotherapy and dexamethasone may be effective but are not recommended for routine use due to adverse effects.
Introduction:
Mechanical ventilation is life saving for many very preterm babies but prolonged use can have adverse effects increasing the risk of subglottic injury and chronic lung disease (CLD). Shorter ventilation should reduce these risks and a number of interventions have been tested to facilitate earlier extubation.
Methods:
The Cochrane Library was searched for systematic reviews of randomised controlled trials of interventions to facilitate extubation and reduce post-extubation atelectasis. These interventions included nasal continuous positive airway pressure (CPAP), nasal intermittent positive pressure ventilation (NIPPV), chest physiotherapy, intravenous dexamethasone and methylxanthine treatment. Outcomes are given as numbers needed to treat (NNT) with 95% confidence intervals (CI).
Results:
Nasal CPAP reduces the incidence of adverse effects after extubation including failure (NNT 6; 95% CI 4-15) and CLD at 28 days (NNT 6; 95% CI 3-22). NIPPV is superior to nasal CPAP at preventing extubation failure (NNT 3; 95% CI 2-5). Chest physiotherapy after extubation does not reduce alveolar atelectasis but it decreases need for re-intubation (NNT 6; 95% CI 4-23). Chest physiotherapy needs to be given 1-2 hourly to obtain this effect. Intravenous dexamethasone reduces the need for re-intubation (NNT 6; 95% CI 3-250) but adverse effects preclude its routine use. Methylxanthines also improve the chances of successful extubation (NNT 4; 95% CI 2-7) and the effect is greatest in infants <1000g birthweight and <7 days postnatal age (NNT 2; 95% CI 1-8).
Conclusions:
Nasal CPAP, NIPPV and methylxanthines are evidence-based treatments to facilitate weaning and extubation of preterm infants but only the first 2 can be recommended for routine use. Chest physiotherapy and dexamethasone may be effective but should not be used routinely because of serious adverse effects.
Related Concept Videos
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)
01:29Mechanical Ventilation I: Indication and Settings
01:21Tracheostomy Decannulation
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals.
01:14Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...