ORIGINAL ARTICLE

Prediction of extubation failure in preterm infants

G Dimitriou, A Greenough, A Endo, S Cherian and G F Rafferty

Children Nationwide Regional Neonatal Intensive Care Unit and Department of Respiratory Medicine, King's College Hospital, London, UK

Correspondence to:
Correspondence to:
Professor Greenough, Department of Child Health, King's College Hospital, London SE5 9RS, UK;
anne.greenough{at}kcl.ac.uk

Objective: To identify whether the results of assessment of respiratory muscle strength or respiratory load were better predictors of extubation failure in preterm infants than readily available clinical data.

Patients: Thirty six infants, median gestational age 31 (range 25–36) weeks and postnatal age 3 (1–14) days; 13 were < 30 weeks of gestational age.

Methods: Respiratory muscle strength was assessed by measurement of maximum inspiratory pressure generated during airway occlusion, and inspiratory load was assessed by measurement of compliance of the respiratory system.

Results: Overall, seven infants failed extubation—that is, they required reintubation within 48 hours. These infants were older (p < 0.01), had a lower gestational age (p < 0.01), and generated lower maximum inspiratory pressure (p < 0.05) than the rest of the cohort. Similar results were found in the infants < 30 weeks of gestational age. Overall and in those < 30 weeks of gestational age, gestational age and postnatal age had the largest areas under the receiver operator characteristic curves.

Conclusion: In very premature infants, low gestational age and older postnatal age are better predictors of extubation failure than assessment of respiratory muscle strength or respiratory load.

Keywords: prematurity; respiration; extubation; ventilation

Abbreviations: CPAP, continuous positive airways pressure; CRS, compliance of the respiratory system; IP, inspiratory pressure; MIP, maximum inspiratory pressure; PIP, peak inspiratory pressure; FIO2, inspired oxygen concentration; ROC, receiver operator characteristic

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