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Prediction of extubation failure in preterm infants
G Dimitriou1, A Greenough, A Endo
1Children Nationwide Regional Neonatal Intensive Care Unit and Department of Respiratory Medicine, King's College Hospital, London, UK.
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.