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.

本章重点介绍新生儿围拔管期的药物管理，以降低再次插管和长时间机械通气的风险。用于促进呼吸驱动、降低呼吸暂停风险、减少肺部炎症和避免支气管痉挛的药物都经过严格评估。如果有的话，Cochrane 综述和随机试验将被用作主要证据来源。甲基黄嘌呤，特别是咖啡因，已得到充分研究，并且有越来越多的证据可以指导临床医生可能使用的时间和剂量。总结了多沙普仑、类固醇、肾上腺素和沙丁胺醇的功效和安全性。介绍了足月婴儿的管理、手术后拔管、意外和复杂拔管以及带套囊气管插管的使用。总体而言，咖啡因是唯一具有大量证据基础的药物，被证明可以增加早产儿成功拔管的可能性；大多数足月儿不需要药物来促进拔管。未来的研究可能会进一步明确咖啡因在晚期早产儿中的作用，并评估对甲基黄嘌呤不敏感的拔管后喘鸣、支气管痉挛或呼吸暂停的药物。