Analysis of predictive parameters for extubation in very low birth weight preterm infants

Yi-Hui Chen; Hui-Ling Lin; Yi-Hsiang Sung; Jen-Fu Hsu; Shih-Ming Chu

doi:10.1016/j.pedneo.2022.08.007

Analysis of predictive parameters for extubation in very low birth weight preterm infants

Pediatr Neonatol. 2023 May;64(3):274-279. doi: 10.1016/j.pedneo.2022.08.007. Epub 2022 Nov 14.

Authors

Yi-Hui Chen¹, Hui-Ling Lin², Yi-Hsiang Sung³, Jen-Fu Hsu⁴, Shih-Ming Chu⁵

Affiliations

¹ Department of Respiratory Therapy, Hsinchu Mackay Memorial Hospital, Taiwan.
² Chang Gung University, Department of Respiratory Therapy, Taoyuan, Taiwan.
³ Hsinchu Mackay Memorial Hospital, Division of Neonatology, Department of Pediatrics, Hsinchu, Taiwan.
⁴ Chang Gung Memorial Hospital, Division of Neonatology, Department of Pediatrics, Taoyuan, Taiwan.
⁵ Chang Gung Memorial Hospital, Division of Neonatology, Department of Pediatrics, Taoyuan, Taiwan. Electronic address: kz6479@cgmh.org.tw.

PMID: 36443202
DOI: 10.1016/j.pedneo.2022.08.007

Abstract

Background: Mechanical ventilation is the primary treatment for preterm infants with respiratory failure. Prolonged intubation may lead to complications; thus, early extubation is desirable. No standard criteria exist for determining the appropriateness of extubating very-low-birth-weight (VLBW) infants. This study explored the predictors of successful extubation in preterm VLBW infants.

Methods: This retrospective cohort study included 60 preterm VLBW infants who underwent their first extubation in the neonatal intensive care unit in a regional hospital in Hsinchu, Taiwan, between January 2017 and November 2020. Successful extubation was defined as having no requirement of reintubation within 3 days of extubation. Potentially predictive variables, including demographics, prenatal characteristics, and ventilator parameters were compared between a successful extubation group and failed extubation group.

Results: Of the 60 infants, 47 (78.33%) underwent successful extubation. The successful extubation group had higher Apgar scores at 1 (7 vs. 6, P = 0.02) and 5 min (9 vs. 7, P = 0.007) than those of the failed extubation group. Ventilator inspiratory pressure and mean airway pressure were significantly lower at 24, 16, 8, and 1 h before extubation and upon its completion in the successful extubation group. The areas under a number of the receiver operating characteristic curve curves in this study were moderate, specifically, 0.72, 0.74, and 0.69. Statistical analysis revealed an association between ventilator parameters before 1 h extubation (IP > 17.5cmH₂O, MAP >7.5 cmH₂O, RSS >1.82) and extubation failure (odds ratio 1.73, 2.27, 2.46 and 95% confidence interval:1.16-2.6, 1.26-4.08, 1.06-5.68, respectively).

Conclusion: Higher Apgar scores at birth, lower ventilator inspiratory pressure, and mean airway pressure 24, 16, 8, and 1 h and 1 h RSS prior to extubation are associated with successful extubation in VLBW preterm infants.

Keywords: Extubation; Mechanical ventilation; Very low birth weight preterm infants.

MeSH terms

Airway Extubation*
Humans
Infant
Infant, Newborn
Infant, Premature*
Infant, Very Low Birth Weight
Respiration, Artificial
Retrospective Studies
Ventilator Weaning