1342 Risk Factors Associated with Extubation Failure (EF) in Extremely Low Gestational Age Newborns (ELGAN)

Abstract

Aims: To analyze influence of perinatalcharacteristics(PC), mechanical ventilator(MV)parameters and early morbidity on EF of ELGANwith birth weight (BW)< 1000g. Methods: This is a retrospective cohort of allELGAN< 28 weeks gestational age(GA) and BW<1000g born between 2004-2009 with MV started inthe first week of life. EF was defined as the needfor reintubation within 48h after the first extubationattempt. Results: 165 infants were included. GA 25.9±1.1w, BW 788.2±126.5g. First extubation attempt was at11.5±14.6d (median 6d). Nasal CPAP was used in allpatients and nasal IMV in 78.4%. EF was 30.9%. Comparing EF infants with those who succeedwe didn't find any differences regarding PC. MVparameters and use of nasal IMV were similarbetween groups. EF group presented higher ratesof late bronchopneumonia and MV length. Extubation from A/C mode vs SIMV was earlier (7.6vs 13.3d, p=0.007), with shorter time constant (51vs 74.1, p=0.000) and higher mean airway pressureand rescue rate (7.1 vs 5.5 cmH2O, p=0.000; 39.4vs 24.5 rpm, p=0.000); compliance, minute-volumeand EF (29 vs 29.6%) were similar. ELGAN with BW< 750g had no significant differencein EF (37.3 vs 27.4%) although reintubation ratewas higher (81.4 vs 51.4%, p=0.000). Conclusion: This study does not support GA orBW as risk factors for EF in this population. BW<750g did not determine a higher EF rate, although itcould be a risk factor for later reintubation. Extubation from A/C mode allows early extubationwithout increase of EF.