Extubation Bundle, Is It Applicable to Reduce The Rate of Reintubation, Among Preterm Neonates?

Respiratory support in the form of mechanical ventilation is a crucial intervention in premature neonates, with respiratory problems. However, prolonged mechanical ventilation and endotracheal intubation may be associated with major adverse effects, such as ventilation-associated pneumonia (VAP), pneumothorax, bronchopulmonary dysplasia (BPD) and periventricular hemorrhage. To minimize such risks and complications, it is recommended to discontinue MV as soon as babies are able to maintain spontaneous breathing and achieve appropriate gas exchange with minimal respiratory effort. The ideal time for extubation is based on clinical and laboratory parameters assessed at the time of planned extubation. However, such parameters are not very objective, which makes extubation in NICUs a trial-and-error approach. Based on the morbidities associated with the long duration of MV in newborn babies, there is a clear need to establish objective criteria for extubation and avoid reintubation. In this editorial, we will focus on the extubation bundle (including MODIFIED SBT) prior to extubation which can independently predict successful extubation in preterm babies.