In neonatal intensive care, endotracheal intubation is usually performed as an urgent or semi-urgent procedure in infants with critical or unstable conditions related to progressive respiratory failure. Extubation is not. Patients undergoing extubation are typically stable, with improved respiratory function. The key elements to facilitating extubation are to recognize improvement in respiratory status, promote weaning of mechanical ventilation, and accurately identify readiness for removal of the endotracheal tube. Therefore, extubation should be a planned and well-organized procedure. In this review, we will appraise the evidence for existing predictors of extubation readiness and provide patient-specific, pathophysiology-derived strategies to optimize the timing and success of extubation in neonates, with a focus on extremely preterm infants.

在新生儿重症监护中，气管插管通常作为紧急或半紧急手术，用于患有与进行性呼吸衰竭相关的危重或不稳定状况的婴儿。拔管则不然。接受拔管的患者通常情况稳定，呼吸功能有所改善。促进拔管的关键要素是识别呼吸状态的改善，促进机械通气的撤机，并准确确定拔除气管插管的准备情况。因此，拔管应该是一个有计划、组织良好的过程。在这篇综述中，我们将评估现有拔管准备预测因素的证据，并提供针对患者的、病理生理学衍生的策略，以优化新生儿拔管的时机和成功率，重点关注极早产儿。