In an effort to enhance respiratory outcomes for preterm infants, our quality improvement project has implemented a peri-extubation guideline, for all infants born before 29 weeks' gestation. 
This approach was informed by a systematic review and a recent unit audit that revealed a high re-intubation rate. Our standardized care includes pausing enteral feeds for two hours before and after extubation, maintaining IV access for hydration and emergency medication administration, and providing positive pressure ventilation via the endotracheal tube with a flow-inflating bag throughout the extubation procedure. Specifically, infants older than 72 hours, with an intubated mean airway pressure (MAP) of 13 or less and with a leak rate under 50%, are to receive post-extubation CPAP at levels 2 cmH2O higher than the pre-extubation MAP. The primary objective of this initiative is to reduce the re-intubation rate by 50%, aiming to significantly improve the care and outcomes of these vulnerable neonates.

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