1.1Improving the success rate of extubation and withdrawal and
reducing the duration of mechanical ventilation
Mechanical ventilation is known to be one of the most important risk
factors for BPD in preterm infants. The lung of preterm infants are
poorly developed and require additional mechanical ventilation support,
However, invasive mechanical ventilation can exacerbate lung epithelial
cell damage and lead to BPD.Caffeine may shorten the duration of
mechanical ventilation and reduce the risk of BPD. Systematic reviews
and meta-analyses have shown that methylxanthines reduce extubation
failure, and strongly recommend the use of caffeine20.
Previous studies in the apnea of prematurity (AOP) randomized controlled
trial found that caffeine reduced the duration of positive pressure
ventilation and attenuated the incidence of BPD in infants with very low
birth weight14. With regards to the of timing of
caffeine treatment, several retrospective cohort studies confirmed that
the duration of mechanical ventilation was shorter in infants treated
with caffeine in the early stages 21 and that the
mortality rate and incidence of BPD were lower among infants treated
early with caffeine than those who received caffeine
later22. However, another study reported a lower
incidence of BPD (23.1% versus 30.7%) but a higher mortality rate
(4.5% versus 3.7%) in infants who received caffeine
early23.
In terms of caffeine dosing, two randomized controlled trials showed
that high doses of caffeine led to a significant reduction in the
failure rate of extubation and reduced the duration of mechanical
ventilation in prematurely ventilated infants24,25.In
another study of the effect of maintenance doses of caffeine on
extubation in preterm infants, higher maintenance doses of caffeine
citrate reduced the incidence of extubation failure and apnea in preterm
infants26. Interestingly, a systematic review and
meta-analysis found that high-dose caffeine (>20 mg/kg.d)
reduced cases of failed extubation and apnea and shortened the duration
of mechanical ventilation, but had no effect on mortality or the
incidence of BPD27.Anis et al.conducted a further
controlled study of the prophylactic use of high-dose caffeine for the
prevention of apnea and found that lower doses of caffeine may be as
effective as higher doses of caffeine in preventing apnea, but fewer
adverse effects28. Unfortunately, the study only
analyzed short-term efficacy and did not consider the effects of
caffeine on long-term outcomes such as BPD. Therefore, the potential
role of caffeine in reducing mechanical ventilation remains to be
further investigated.