Facteurs associés à un échec d’extubation chez le nouveau-né prématuré de moins de 32 semaines d’aménorrhée

Abstract

Even though ventilatory support for preterm infants has improved over the past few decades, about 30% of intubated preterm infants fail an extubation attempt. There are still no simple standards to determine the optimal extubation time for those infants. To identify factors related to extubation success or failure in preterm infants less than 32 weeks of gestation (WG). Retrospective study including 162 newborns less than 32 WG, requiring mechanical ventilation within the first 24h of life. Successful extubation was defined as no need for reintubation for any reason at least 7 days after the first extubation attempt. Forty-one infants failed extubation (25.3%); 149 infants (92%) had mechanical ventilation in their first 30min of life. These infants had a lower gestational age (p<0.001) and a lower birth weight (p=0.003). They required a higher FiO(2) (p<0.001) and maximum inspiratory pressure (p=0.002). The infants who failed extubation had a lower pH (p=0.001) and hematocrit (p=0.032), and a higher PCO(2) (p=0.003). As previously described, a low gestational age is a major factor predicting the extubation failure. However, our data suggests that ventilator settings and blood gas should also be considered when attempting extubation, following written guidelines.