Prediction of extubation failure in preterm infants

Dimitriou, Gabriel; Greenough, Anne; Endo, Aiju; Cherian, Shobha; Rafferty, Gerrard F.

doi:10.1136/fn.86.1.f32

Cited by 82 publications

(82 citation statements)

References 16 publications

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“…10 In some studies we verified variable rates in relation to extubation failure, sometimes associated with lower birth weight and gestational age. 1, 15,20,21 As such, we sought to verify if there was a relationship between extubation failure in the two methods and the BW and GA, classification of the premature infant, and the MV time. We found that there was no significant difference between the association of the characteristics described and the methods under study.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation

Komatsu

Diniz

Ferraro

et al. 2016

Rev. Assoc. Med. Bras.

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Objective:To analyze the frequency of extubation failure in premature infants using conventional mechanical ventilation (MV) after extubation in groups subjected to nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (nCPAP). Method: Seventy-two premature infants with respiratory failure were studied, with a gestational age (GA) ≤ 36 weeks and birth weight (BW) > 750 g, who required tracheal intubation and mechanical ventilation. The study was controlled and randomized in order to ensure that the members of the groups used in the research were chosen at random. Randomization was performed at the time of extubation using sealed envelopes. Extubation failure was defined as the need for re-intubation and mechanical ventilation during the first 72 hours after extubation. Results: Among the 36 premature infants randomized to nIPPV, six (16.6%) presented extubation failure in comparison to 11 (30.5%) of the 36 premature infants randomized to nCPAP. There was no statistical difference between the two study groups regarding BW, GA, classification of the premature infant, and MV time. The main cause of extubation failure was the occurrence of apnea. Gastrointestinal and neurological complications did not occur in the premature infants participating in the study. Conclusion: We found that, despite the extubation failure of the group of premature infants submitted to nIPPV being numerically smaller than in premature infants submitted to nCPAP, there was no statistically significant difference between the two modes of ventilatory support after extubation.

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Section: Discussionmentioning

confidence: 99%

Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation

Komatsu

Diniz

Ferraro

et al. 2016

Rev. Assoc. Med. Bras.

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“…These data have show increased extubation failure risk for higher FiO 2 and lower current body weight. Hermeto et al (15) have shown a 23% extubation failure rate in a population with birth weight < 1,250 g and 35% with birth weight < 1,000 g. Additionally, the Dimitriou et al (4) study has shown that neonates with lower birth weight (among other factors) and pre-extubation higher FiO 2 were associated with extubation failure.…”

Section: Resultsmentioning

confidence: 95%

“…Several studies confirm our results, indicating among the main failure causes apnea and increased respiratory load. (4,16) Sinha and Donn (29) say that children with no respiratory distress or worsened gas exchange during the test had between 60% to 80% chance to require no artificial airway support.…”

Section: Discussionmentioning

confidence: 99%

“…(4,5,14) In this study we analyzed SBT, which is a simple criterion for MV discontinuation success prediction, as the best time for newborns and children extubation Rev Bras Ter Intensiva. 2010; 22(2):159-165 ble clinical features that rendered them eligible for weaning, 19 (63.3%) of the control group newborns had extubation failures.…”

Section: Discussionmentioning

confidence: 99%

“…The exposure of the immature lung to the postnatal or intensive care environments renders it susceptible to injuries due to its incomplete anatomical differ- entiation, (2) explaining why about 70% of the preterm newborns require mechanic ventilation (MV) during their clinical course. (3)(4)(5) MV is one of the main resources for these patients' life support. Nevertheless its universally accepted benefits, there are associated risks, as it may contribute to the start or worsening of lung and distant organs injuries, and is one of the responsible for increased morbidity and mortality factors .…”

Section: Introductionmentioning

confidence: 99%

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Avaliação do teste de respiração espontânea na extubação de neonatos pré-termo

Andrade¹,

Melo²,

Morais³

et al. 2010

Rev. bras. ter. intensiva

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Effectiveness of Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation vs Noninvasive High-Frequency Oscillatory Ventilation as Support After Extubation of Neonates Born Extremely Preterm or With More Severe Respiratory Failure

Zhu

Shi

et al. 2023

JAMA Netw Open

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ImportanceThe NASONE (Nasal Oscillation Post-Extubation) trial showed that noninvasive high-frequency oscillatory ventilation (NHFOV) slightly reduces the duration of invasive mechanical ventilation (IMV) in preterm infants, whereas NHFOV and noninvasive intermittent positive pressure ventilation (NIPPV) result in fewer reintubations than nasal continuous positive airway pressure (NCPAP). It is unknown whether NHFOV is similarly effective in extremely preterm neonates or in those with more severe respiratory failure (based on the duration of previous ventilation and CO2 levels).ObjectiveTo clarify whether NHFOV is better than NIPPV and NCPAP in reducing the duration of IMV in extremely preterm neonates or those with severe respiratory failure.Design, Setting, and ParticipantsThis study is a predefined secondary analyses of a multicenter randomized clinical trial that was performed at tertiary academic neonatal intensive care units (NICUs) in China. Participants included neonates enrolled in the NASONE trial between December 2017 and May 2021 and belonging to 3 predefined subgroups: (1) born at less than or equal to 28 weeks’ (plus 6 days) gestation, (2) invasively ventilated for more than 1 week from birth, and (3) with CO2 greater than 50 mm Hg before or in the 24 hours after extubation. Data analysis was performed in August 2022.InterventionNCPAP, NIPPV, or NHFOV since the first extubation and until NICU discharge, with airway pressure higher in NHFOV than in NIPPV and than in NCPAP.Main Outcomes and MeasuresThe co–primary outcomes were total duration of IMV during the NICU stay, need for reintubation, and ventilator-free days calculated as per the original trial protocol. Outcomes were analyzed on an intention-to-treat basis as for the whole trial, and subgroup analyses followed the original statistical plan.ResultsAmong 1137 preterm infants, 455 (279 boys [61.3%]) were born at 28 weeks’ gestation or less, 375 (218 boys [58.1%]) underwent IMV for more than 1 week from birth, and 307 (183 boys [59.6%]) had CO2 greater than 50 mm Hg before or in the 24 hours after extubation. Both NIPPV and NHFOV were associated with significantly fewer reintubations (risk difference range, −28% [95% CI, −39% to −17%] to −15% [95% CI, −25% to −4%]; number needed to treat, 3-7 infants) and early reintubations (risk difference range, −24% [95% CI, −35% to −14%] to −20% [95% CI, −30% to −10%]) than NCPAP, and these reintubations were less frequently due to refractory hypoxemia. IMV was shorter in the NIPPV and NHFOV groups (mean difference range, −5.0 days [95% CI, −6.8 to −3.1 days] to −2.3 days [95% CI, −4.1 to −0.4 days]) than in the NCPAP group. Co–primary outcomes were not different between NIPPV and NHFOV; there was no significant interaction effect. Infants in the NHFOV group showed significantly less moderate-to-severe bronchopulmonary dysplasia than infants in the NCPAP group (range, −12% to −10%; number needed to treat, 8-9 infants) and better postextubation gas exchange in all subgroups. The 3 interventions were provided at different mean airway pressure and were equally safe.Conclusions and RelevanceThe subgroup analyses of extremely preterm or more ill infants confirm the results obtained in the whole population: NIPPV and NHFOV appeared equally effective in reducing duration of IMV compared with NCPAP.Trial RegistrationClinicalTrials.gov Identifier: NCT03181958

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Prediction of extubation failure in preterm infants

Cited by 82 publications

References 16 publications

Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation

Randomized controlled trial comparing nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants after tracheal extubation

Avaliação do teste de respiração espontânea na extubação de neonatos pré-termo

Effectiveness of Nasal Continuous Positive Airway Pressure vs Nasal Intermittent Positive Pressure Ventilation vs Noninvasive High-Frequency Oscillatory Ventilation as Support After Extubation of Neonates Born Extremely Preterm or With More Severe Respiratory Failure

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