What interventions facilitate weaning from the ventilator? A review of the evidence from systematic reviews

Paediatric Respiratory Reviews
Henry L Halliday

Abstract

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. 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). 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 dexametha...Continue Reading

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Citations

Sep 28, 2010·Italian Journal of Pediatrics·Carmen GiannantonioCostantino Romagnoli
Jul 7, 2009·Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie·C DeguinesP Tourneux
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Aug 30, 2006·Acta Paediatrica·Jan EndersMatthias Knüpfer
Apr 17, 2012·Pediatric Pulmonology·Yuval CavariIsaac Lazar
Jun 27, 2006·Paediatric Respiratory Reviews·Maggie McIlwaine
Jun 30, 2010·International Journal of Technology Assessment in Health Care·Karen FaceyAnn Single
Jun 9, 2007·Folia Phoniatrica Et Logopaedica : Official Organ of the International Association of Logopedics and Phoniatrics (IALP)·Kathryn M Yorkston
Nov 3, 2010·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Gabriel DimitriouStefanos Mantagos

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