Spontaneous minute ventilation is a predictor of extubation failure in extremely-low-birth-weight infants

Abstract

Objective: To validate the percentage of time spent below a target value of spontaneous expiratory minute ventilation (<125 ml/min per kg) during a 2-h period of continuous positive airway pressure (CPAP) via an endotracheal tube (ETT) as a predictor of failed extubation in preterm infants.Methods: Forty-one infants intubated for at least 24 h, with birth weight between 500 and 1000 g, who were clinically stable and at ventilator setting compatible with an extubation attempt, were studied during a 2-h period of ETT CPAP. Dynamic lung compliance and total lung resistance were measured during a period of quiet breathing, while tidal volume (Vt), respiratory rate and the corresponding spontaneous expiratory minute ventilation values were calculated for the complete recording period of 2 h using a customized computer program. The time each patient spent below the target spontaneous expiratory minute ventilation value was reported as a percentage of the total recorded time (% spontaneous expiratory minute ventilation <125 ml/min per kg). Extubation failure was defined as the need for reintubation within 72 h.Results: Eleven out of 41 babies (26.8%) experienced failure of extubation (failure group) while 30 infants (73.2%) were successfully extubated (success group). There were no significant differences in dynamic lung compliance and lung resistance between the two groups, but the mean values of respiratory rate and spontaneous expiratory minute ventilation were significantly lower in the failure group than in the success group: 43 (37–56) breaths/min and 240 (160–353) ml/min per kg vs. 53 (28–67) breaths/min and 309 (223–434) ml/min per kg, respectively (p=0.0129 and p=0.0039). Moreover, the babies in whom extubation failed spent a longer time below the target value of spontaneous expiratory minute ventilation when compared with successfully extubated babies (p<0.0001). Percentage of time spent with spontaneous expiratory minute ventilation <125 ml/min per kg had a larger area than transcutaneous (Tc)PCO2, TcPO2and pulse oxymetry saturation (SpO2) under the receiver operator characteristic curves.Conclusion: The measurement of spontaneous expiratory minute ventilation prior to extubation could be useful in identifying those babies who are not ready for spontaneous ventilation.