Relationship Between the Respiratory Severity Score and Extubation Failure in Very-low-birth-weight Premature Infants

Abstract

Objective: The objective of the study is to investigate the utility of the respiratory severity score (RSS), an easy-to-use, non-invasive respiratory failure assessment tool that does not require arterial blood sampling, for predicting extubation failure in very-low-birth-weight premature infants. Methods: Demographic characteristics, clinical course, and neonatal morbidities were retrospectively analyzed. Data were obtained from the files of infants who were admitted to our unit between February 2016 and September 2020, were born before 30 weeks’ gestation, and had a birth weight <1250 g. Extubation success was defined as no need for reintubation for 72 h after extubation. RSS and RSS/kg values before each patient’s first planned extubation were calculated. RSS values before extubation and risk factors for extubation failure were compared between infants in the successful and failed extubation groups. Results: Our study enrolled 142 infants who met the inclusion criteria. The extubation failure rate was 30.2% (43/142). Early gestation, low birth weight, male sex, high RSS, grade ≥3 intraventricular hemorrhage, late-onset sepsis, low weight at the time of extubation, and postmenstrual age at the time of extubation were identified as risk factors for extubation failure. In the logistic regression analysis including these risk factors, RSS/kg remained a significant risk factor, along with late-onset sepsis (OR 25.7 [95% CI: 5.70–115.76]; p <0.001). In the receiver operating characteristic analysis of RSS values, at a cutoff value of 2.13 (area under the curve: 82.5%), RSS/kg had 77% sensitivity and 78% specificity ( p <0.001). The duration of mechanical ventilation and hospital stay were prolonged in infants with extubation failure. The incidence rates of stage ≥3 retinopathy of prematurity and stage ≥2 necrotizing enterocolitis were also higher. Conclusions: High RSS and RSS/kg values were closely associated with extubation failure and can be used as a non-invasive assessment tool to support clinical decision-making, and thus reduce the rate of extubation failure.

Predictors of extubation failure in newborns: a systematic review and meta-analysis

“…Of these studies, 19 were prospective studies [ 17 , 19 , 23 – 39 ] and the remaining 15 studies were retrospective [ 10 , 16 , 40 – 52 ], of which seven were multicenter studies [ 16 , 17 , 19 , 23 , 37 , 39 , 49 ] and 27 were single-center studies [ 10 , 24 – 36 , 38 , 40 – 48 , 50 – 52 ].The sample size ranged from 34 to 926, with the two largest studies including 394 newborns [ 40 ] and 926 newborns [ 17 ], respectively. Three of these studies constructed clinical prediction models [ 16 , 42 , 49 ].…”

“…The main causes of reintubation for EF were frequent apnea, increased respiratory workload, and hypoxemia [ 53 ]. There is evidence that EF is strongly associated with adverse clinical outcomes and mortality [ 10 , 16 , 19 , 40 , 44 ].…”

“…The scientific basis for determining when a patient is ready for extubation is still imprecise, despite significant advancements in MV and post-extubation respiratory support in neonatology. Clinical judgment, personal experience, bedside observation of blood gases, oxygen requirements, and ventilator settings are typically used to make decisions on whether to extubate [ 9 , 10 ]. Consequently, there are significant practical differences and a paucity of protocols to simplify the management of all components of the peri-extubation process, with decisions often being physician-dependent rather than evidence-based, which may lead to inappropriate extubation [ 11 – 13 ].…”

Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study

“…The respiratory severity score is a respiratory index that can evaluate the severity of oxygenation failure and pulmonary status in patients receiving MV, which is calculated by multiplying MAP and FiO 2 , and can be used as an alternative to the oxygenation index, which requires invasive arterial catheterization [ 22 ]. EF patients showed a higher RSS on the first extubation attempt than ES patients [ 8 , 23 , 24 ]. However, this difference was not statistically significant, possibly because of the small number of patients included in our study.…”

Risk factors and clinical outcomes of extubation failure in very early preterm infants: a single-center cohort study

“…Respiratory severity score is a respiratory index that can evaluate the severity of oxygenation failure and pulmonary status in patients receiving MV, which is calculated by multiplying MAP and FiO2; it can be used as an alternative to oxygenation index (OI), which requires invasive arterial catheterization [17]. EF patients showed a higher RSS at the rst attempt of extubation in the previous studies [8,18,19], and the EF group in this study showed a higher RSS at the rst attempt of extubation than the ES group. However, this difference was not statistically signi cant.…”