Prediction of extubation failure in preterm infants
- Children Nationwide Regional Neonatal Intensive Care Unit and Department of Respiratory Medicine, King's College Hospital, London, UK
- Correspondence to:
Professor Greenough, Department of Child Health, King's College Hospital, London SE5 9RS, UK;
anne.greenough{at}kcl.ac.uk
- Accepted 23 August 2001
Abstract
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.
- 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
