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| Author | Kind of study | Inclusion criteria INSURE | Exclusion criteria INSURE | Definition of intubation conditions | Definition of INSURE failure | Predefined side effects |
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Ancora et al. [26] | Retrospective case control study | FiO2 requirement > 0.40 on nCPAP > 30 min to maintain SpO2 values 85–93% in presence of radiological signs of RDS | Not reported | Not defined | FiO2 > 0.40 on nCPAP, intractable apnea (>4 episodes of apnea/hour or >2 episodes of apnea/hour requiring bag and mask ventilation) or severe respiratory acidosis (pH < 7.2 and pCO2 > 70 mmHg) within 7 days from extubation | Not defined |
|
Van den Berg et al. [22] | Prospective cohort study | Not reported | Not reported | Not defined | Not defined | Not defined |
| Bohlin et al. [23] | Retrospective descriptive study | Preterm with RDS on nCPAP with a/A ratio ≤ 0.22 | Infants requiring intubation as part of resuscitation at birth | Not defined | Need for mechanical ventilation in the first week after surfactant treatment. Need for MV: PaCO2 ≥ 8.5 kPa, FiO2 ≥ 0.60, signs of severe respiratory distress or apneas | Not defined |
| Cherif et al. [20] | Retrospective case study | GA > 27 weeks, a/A ratio ≤ 0.25 on nCPAP | Not reported | Not defined | Need for MV during 72 hours after surfactant treatment. Criteria for MV: > 3 episodes of apnea in 3-hour unresponsive stimulation or caffeine treatment, arterial pH < 7.20, arterial pCO2 > 65 mmHg, a/APO2 < 0.15, metabolic acidosis not responsive to treatment | Not defined |
| Gizzi et al. [25] | Retrospective case study | FiO2 requirement > 0.40 on nCPAP > 30 min to maintain SpO2 values 85–93% in the presence of radiologic signs of RDS | Not reported | Not reported | FiO2 > 0.40 to maintain SpO2 85–93%, significant apnea defined as >4 episodes of apnea/hour or >2 episodes of apnea/hour requiring bag and mask ventilation, respiratory acidosis (pCO2 > 65 mmHg and pH < 7.20) | Not reported |
|
Flor-de-Lima et al. [18] | Retrospective case control study | FiO2 > 0.40 with respiratory distress and/or arterial pCO2 > 65 mmHg and pH < 7.20 on nCPAP | Not reported | Not defined | Not defined | Not defined |
| Leone et al. [27] | Case control study | Preterm with RDS on nCPAP with a/A ratio ≤ 0.22 | Infants requiring intubation as part of resuscitation at birth or later as part of respiratory failure | | Need for MV during admission to the NICU. Criteria for MV: PaCO2 ≥ 8.5 kPa, FiO2 ≥ 0.60, signs of severe respiratory distress or apneas | |
| Sandri et al. [24] | RCT | GA 28–32 weeks, inborn, FiO2 on nCPAP > 0.40 for more than 30 minutes to maintain SpO2 93–96% and radiographic signs of RDS | | | Need for MV during first week of life. Criteria for MV: FiO2 > 0.40 to maintain SpO2 85–93%, significant apnea defined >4 episodes of apnea/hour or >2 episodes of apnea/hour requiring bag and mask ventilation, respiratory acidosis (pCO2 > 65 mmHg and pH < 7.20), FiO2 rapidly increasing above 0.80 | |
| Verder et al. 1994 [19] | RCT | GA 25–35 weeks, clinical and radiologic findings of RDS, age 2–72 hours, requirement for nCPAP with PEEP ≥ 6 cmH2O, a/A ratio ≤ 0.22 | Apgar score < 3 at 5 minutes, rupture of membranes > 14 days, severe malformations, pneumonia, pneumothorax | Not defined | Not defined | Not defined |
| Verder et al. 1999 [21] | RCT | GA < 30 weeks, postnatal age 2–72 hours, treated with nCPAP ≥ 6 cmH2O for RDS, a/A ratio 0.35–0.22 decreasing over a period of >30 min | Apgar score ≤ 2 at 5 min, prolonged rupture of membranes > 3 weeks, lethal malformations, pneumonia, incompletely treated pneumothorax | Not defined | Need for MV within 7 days of birth. Criteria for MV: a/A values < 0.15 decreasing further over a period of >30 min, severe apnea defined as >4 episodes per hour or need for mask ventilation > 2 times per hour, or inability to extubation within 1 hour after INSURE | Not defined |
| Welzing et al. 2010 [17] | Prospective cohort study | GA 29–32 weeks, postnatal age < 8 hours, moderate to severe respiratory distress (FiO2 ≥ 0.30 on nCPAP to reach postductal SpO2 ≥ 88% OR Silvermanscore ≥ 6) | Any kind of disease not allowing early extubation | Score of 0–2 on items coughing, breathing, and limb movements. Excellent conditions: score ≤ 1. Good conditions: score 2-3. Inacceptable conditions: score > 3 or distinct coughing or limb movements | Not reported | Hypotension |
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Welzing et al. 2009 | Prospective cohort study | GA 29–32 weeks, postnatal age <8 hours, moderate to severe respiratory distress (FiO2 ≥ 0.30 on nCPAP to reach postductal SpO2 ≥ 88% OR Silvermanscore ≥ 6) | Any kind of disease not allowing early extubation | Score of 0–2 on items coughing, breathing, and limb movements. Excellent conditions: score ≤ 1. Good conditions: score 2-3. Inacceptable conditions: score > 3 or distinct coughing or limb movements | Not reported | Hypotension
Bradycardia
Chest rigidity |
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