Can Fraction of Inspired Oxygen Predict Extubation Failure in Preterm Infants?

Eugenio Spaggiari,Luigi Corradini Zini,Alberto Berardi,Ilaria Bianchedi,Licia Lugli,Isotta Guidotti,Alessandra Boncompagni,Lorenzo Iughetti,Ornella Angela Ricca,Luca Bedetti,Maria Amato,Cecilia Rossi

doi:10.3390/children9010030

Eugenio Spaggiari, Luigi Corradini Zini + Show 10 more

Open Access

https://doi.org/10.3390/children9010030

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Abstract

Background: Prolonged mechanical ventilation in preterm infants may cause complications. We aimed to analyze the variables affecting extubation outcomes in preterm infants at high risk of extubation failure. Methods: This was a single-center, observational, retrospective study. Extubation failure was defined as survival with the need for reintubation within 72 h. Successfully extubated neonates (group 1) were compared to those with failed extubation (group 2). Multivariate logistic regression analysis evaluated factors that predicted extubation outcomes. Results: Eighty infants with a birth weight under 1000 g and/or gestational age (GA) under 28 weeks were included. Extubation failure occurred in 29 (36.2%) and success in 51 (63.8%) neonates. Most failures (75.9%) occurred within 24 h. Pre-extubation inspired oxygen fraction (FiO2) of 27% had a sensitivity of 58.6% and specificity of 64.7% for extubation failure. Post-extubation FiO2 of 32% had a sensitivity of 65.5% and specificity of 62.8% for failure. Prolonged membrane rupture (PROM) and high GA were associated with extubation success in multivariate logistic regression analysis. Conclusions: High GA and PROM were associated with extubation success. Pre- and post-extubation FiO2 values were not significantly predictive of extubation failure. Further studies should evaluate if overall assessment, including ventilatory parameters and clinical factors, can predict extubation success in neonates.

Highlights

Mechanical ventilation (MV) increases survival in preterm infants but may lead to complications when prolonged unnecessarily
The timing of extubation often depends on clinical judgment, after taking into account the birth weight (BW), gestational age (GA), ventilator parameters, blood gas analysis, chest X-rays, and breathing tests
Preterm neonates with a birth weight under 1000 g and/or gestational age under 28 weeks who were admitted to the neonatal intensive care unit (NICU) from 1 December 2010 to 31 December 2019 were enrolled

Summary

Introduction

Mechanical ventilation (MV) increases survival in preterm infants but may lead to complications when prolonged unnecessarily. The timing of extubation often depends on clinical judgment, after taking into account the birth weight (BW), gestational age (GA), ventilator parameters, blood gas analysis, chest X-rays, and breathing tests. These clinical variables were singularly shown to have a low predictive value for extubation failure in previous studies [9,10,11,12,13,14]. The aim of this study is to analyze the predictive factors for extubation failure in a cohort of extremely preterm and/or extremely low birth weight infants. Further studies should evaluate if overall assessment, including ventilatory parameters and clinical factors, can predict extubation success in neonates

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