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.