Both continuous positive airway pressure and nasal intermittent positive pressure ventilation were linked with lower rates of extubation failure in premature infants compared with head-box oxygen, Australian researchers found.

According to a meta-analysis, continuous positive airway pressure (CPAP) was associated with a 41% reduced risk of extubation failure versus head-box oxygen (risk ratio 0.59, 95% CI 0.48-0.72; 6 number needed to treat: six). Nasal intermittent positive pressure ventilation (NIPPV), which uses a mechanical ventilator to deliver positive pressure addition to CPAP, was superior to CPAP alone, with a 30% lower risk of intubation failure (RR 0.70, 95% CI 0.60-0.81; NNT: eight), reported Kristin N. Ferguson, BSc, of the Royal Women’s Hospital in Melbourne, and colleagues.

In addition, administering methylxanthines (which increase respiratory drive) was linked with a more than 50% reduced risk of extubation failure (RR 0.48, 95% CI 0.32-0.71), the authors wrote in JAMA Pediatrics.