Patterns of reintubation in extremely preterm infants: a longitudinal cohort study

Abstract

BackgroundThe optimal approach for reporting reintubation rates in extremely preterm infants is unknown. This study aims to longitudinally describe patterns of reintubation in this population over a broad range of observation windows following extubation.MethodsTiming and reasons for reintubation following a first planned extubation were collected from infants with birth weight ≤1,250 g. An algorithm was generated to discriminate between reintubations attributable to respiratory and non-respiratory causes. Frequency and cumulative distribution curves were constructed for each category using 24 h intervals. The ability of observation windows to capture respiratory-related reintubations while limiting non-respiratory reasons was assessed using a receiver operating characteristic curve.ResultsOut of 194 infants, 91 (47%) were reintubated during hospitalization; 68% for respiratory and 32% for non-respiratory reasons. Respiratory-related reintubation rates steadily increased from 0 to 14 days post-extubation before reaching a plateau. In contrast, non-respiratory reintubations were negligible in the first post-extubation week, but became predominant after 14 days. An observation window of 7 days captured 77% of respiratory-related reintubations while only including 14% of non-respiratory cases.ConclusionReintubation patterns are highly variable and affected by the reasons for reintubation and observation window used. Ideally, reintubation rates should be reported using a cumulative distribution curve over time.

Finally, A Tool to Address Extubation Anxiety!

“…Strengths of this study include the relatively large number of subjects, bootstrapping techniques to obtain confidence intervals, and the similarity of their cohort's extubation success and definitions to other previous studies on this topic. The time window selected for inclusion of reintubation attempts is consistent with other reports that majority of respiratory related reintubations occur within 7 days of extubation [9]. The addition of an online calculator offers the potential for bedside applicability of these findings.…”

Comparison of extubation success using noninvasive positive pressure ventilation (NIPPV) versus noninvasive neurally adjusted ventilatory assist (NI-NAVA)

“…Prevention of reintubation of preterm infants holds significant promise in improving overall outcomes of this fragile population. Cohort studies have reported that almost half of infants with birth weights less than 1500 g and almost two-thirds of infants with birth weights less than 1000 g require at least one reintubation for resumption of invasive positive pressure ventilation during the NICU stay [24][25][26]. The time interval between an extubation and resumption of mechanical ventilation has been reported to range from hours to days [24].…”

The effects of nasal continuous positive airway pressure and high flow nasal cannula on heart rate variability in extremely preterm infants after extubation: A randomized crossover trial

“…Baseline patient demographics (BW, gestational age, sex, APGAR scores, and weight, postnatal age and post‐menstrual age at extubation), pre‐extubation blood gas (pH, partial pressure of CO 2 , bicarbonate, base excess), ventilator settings (ventilation mode, peak inflation pressure (PIP), positive end‐expiratory pressure (PEEP), mean airway pressure (MAP), FiO 2 , and inflation rate), post‐study non‐invasive respiratory support (mode, PIP, PEEP, and inflation rates) and extubation outcomes were prospectively collected. Extubation failure was defined as the need for reintubation within 7 days from extubation . The primary reason for reintubation was also recorded.…”