Predictors of extubation failure and reintubation in newborn infants subjected to mechanical ventilation

Costa, Ana Cristina de Oliveira; Schettino, Renata de Carvalho; Ferreira, Sandra Clecêncio

doi:10.5935/0103-507x.20140008

Cited by 23 publications

(23 citation statements)

References 18 publications

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“…This suggests that postextubation arterial pH values and bicarbonate levels may identify the ELBW infants with high risk of reintubation after extubation earlier. Similar findings were reported by Costa et al, 24 who claimed that low pH and bicarbonate level exhibited association with extubation failure. Poor ventilation leads to poor perfusion and metabolic acidosis may ensue from tissue hypoxia and anaerobic metabolism.…”

Section: Discussionsupporting

confidence: 90%

Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants

Wang

Liou

Chen

et al. 2017

Pediatrics & Neonatology

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Section: Discussionsupporting

confidence: 90%

Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants

Wang

Liou

Chen

et al. 2017

Pediatrics & Neonatology

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“…9 Lower GA, prolonged ventilation (>2 weeks), low 5-minute Apgar score, low pre-extubation blood pH, and extubation from higher ventilatory settings and failed spontaneous breathing test have been noted to be associated with extubation failure. 12,15,16 …”

Section: Discussionmentioning

confidence: 99%

Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation

Chawla

Natarajan

Shankaran

et al. 2017

The Journal of Pediatrics

112

104

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Objectives To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network’s Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks’ gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/bronchopulmonary dysplasia (OR 3.27). Conclusions Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration ClinicalTrials.gov: NCT00233324.

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“…Timely removal of the ETT decreases mechanical ventilation duration [5], decreases the need for potentially harmful sedatives [7], and relieves patient and parental distress [8]. On the other hand, extubation failure is a common problem in the NICU, with 20% to 35% of preterm and 13% of term infants failing their first extubation attempt [9, 10].…”

Section: Introductionmentioning

confidence: 99%

Effects of an extubation readiness test protocol at a tertiary care fully outborn neonatal intensive care unit

Mandhari¹,

Finelli²,

Chen³

et al. 2019

Can J Respir Ther

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Background and objectivesExtubation readiness testing (ERT) in the Neonatal Intensive Care Unit (NICU) is highly variable and lacking standardized criteria. To address this gap, an evidence-based, inter-professionally developed ERT protocol was implemented to assess effectiveness on extubation failure within 72 h and on duration of intubation (DOI).MethodsA longitudinal retrospective chart review in a level III, fully outborn NICU, of intubated infants admitted 1-year prior (Group 1), and 1 year after implementation (Group 2). Patients were extubated if they passed a 2-stage ERT protocol (3 min continuous positive airway pressure (CPAP) followed by 7 min CPAP + pressure support). Descriptive, comparative statistics, and univariate and multiple logistic regression were completed on all patients and a ≤32 6/7 weeks subgroup (intubated at day-of-life 1); p < 0.05 is considered significant.ResultsAll patients (n = 589 (n = 294 Group 1, n = 295 Group 2)) were included (preterm, intubated day of life one subgroup: n = 42 Group 1, n = 38 Group 2). For all patients, extubation failure decreased significantly from 9.9% to 4.1% (p = 0.006); Group 1 patients were 2.42 times more likely to experience extubation failure compared with Group 2. Extubation failure in the preterm subgroup decreased from 21.7% to 2.6% (p = 0.01); Group 1 patients were 10.71 times more likely to experience extubation failure. Median DOI was similar in both groups for all patients and in the preterm subgroup.ConclusionsA unique two-stage ERT protocol was effective at reducing extubation failure rate, without increasing DOI, largely in preterm infants. The evidence-based, interprofessionally developed ERT protocol and its integration into the NICU culture largely contributed to its success.

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Predictors of extubation failure and reintubation in newborn infants subjected to mechanical ventilation

Cited by 23 publications

References 18 publications

Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants

Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants

Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation

Effects of an extubation readiness test protocol at a tertiary care fully outborn neonatal intensive care unit

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