The FiO2 is associated with the successful extubation of mechanically ventilated neonates

Abstract

Early extubation may be beneficial in preventing or attenuating the development of bronchopulmonary dysplasia (BPD). We tested the hypothesis that patients extubated from higher ventilator pressures would be more likely to fail extubation. To determine the relationship between peak inspiratory pressure (PIP), positive end expiratory pressure (PEEP), and fraction of inspired oxygen (FiO 2 ) at the time of extubation and success of extubation, we reviewed the charts of all patients extubated in our neonatal intensive care unit (NICU) over two time periods; . Successful extubation was defined as not requiring re-intubation within 36 hours of extubation. There were 67 patients extubated during the study periods, and 58 patients (88%) were successfully extubated. There was no difference in the ventilator settings (PIP, PEEP, mean airway pressure, ventilator rate, or inspiratory time) between the patients with successful vs unsuccessful extubations. However, the FiO 2 was significantly (P = 0.011) lower in the successful extubations (median 24, intraquartile range 21-31) than in the unsuccessful extubations (median 33, intraquartile range 28-43). The median PIP was 22 cm H 2 O (intraquartile range 20-24) in the patients successfully extubated. Our data suggest that the FiO 2 may be the only ventilator setting associated with successful extubations in this patient population. Randomized control trials are needed to determine if extubating neonatal patients from relatively high PIP using FiO 2 will shorten the duration of mechanical ventilation.

Evaluation of Short‐term Outcomes of Tracheostomy Procedures in a NICU Population With High Ventilator Settings

“…Thus, we examined articles describing ventilator settings at the time of extubation attempt and noted ranges of PIP of 13 to 24 cm H 2 O, PEEP of 4 to 6 cm H 2 O, and MAP of 5 to 8 cm H 2 O. [7][8][9] Based on these data and consensus within our group of neonatologists, we determined that PIP greater than 25 cm H 2 O, PEEP greater than 6 cm H 2 O, or mean airway pressure greater than 10 cm H 2 O were ''high ventilator settings.'' Among those with high settings, we performed sensitivity analyses for patients with a PIP, PEEP, or MAP above the 80th percentile and arbitrarily defined those above this cutoff as ''extremely high.''…”

“…There is no literature available to our knowledge that describes average ventilator settings for infants in the NICU. Thus, we examined articles describing ventilator settings at the time of extubation attempt and noted ranges of PIP of 13 to 24 cm H 2 O, PEEP of 4 to 6 cm H 2 O, and MAP of 5 to 8 cm H 2 O 7–9 . Based on these data and consensus within our group of neonatologists, we determined that PIP greater than 25 cm H 2 O, PEEP greater than 6 cm H 2 O, or mean airway pressure greater than 10 cm H 2 O were “high ventilator settings.” Among those with high settings, we performed sensitivity analyses for patients with a PIP, PEEP, or MAP above the 80th percentile and arbitrarily defined those above this cutoff as “extremely high.” Patients requiring extremely high ventilator pressure had at least one of the following measurements: PIP greater than 37 cm H 2 O, PEEP greater than 8 cm H 2 O, and MAP greater than 15.5 cm H 2 O.…”