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Updated: Jul 15, 2025
A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Predictive factors for extubation success in very low and extremely low birth weight preterm infants
Nilson Willamy Bastos de Souza Júnior1, Tathiane Ribeiro Rosa1, Jane Cecília Kreling Cerântola2
1Postgraduation Program in Rehabilitation Sciences Londrina State University.
Insights
Gestational age and post-extubation carbon dioxide levels predict extubation success in preterm infants. Lower birth weight and higher oxygen levels before extubation were linked to extubation failure in these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Prolonged invasive mechanical ventilation (IMV) in extremely low birth weight (ELBW) infants is linked to poor outcomes.
- Identifying predictors for successful extubation is crucial for improving clinical results in very low birth weight (VLBW) and ELBW preterm infants.
Purpose of the Study:
- To identify key factors predicting successful extubation in VLBW and ELBW preterm infants.
- To analyze variables associated with extubation success versus failure in this high-risk population.
Main Methods:
- A cohort study included preterm infants (gestational age <36 weeks, birth weight <1500 grams) undergoing IMV between 2015-2018.
- Infants were categorized into extubation success and failure groups.
- Stepwise logistic regression identified variables associated with successful extubation.
Main Results:
- Gestational age (GA) and post-extubation arterial partial pressure of carbon dioxide (PaCO2) were significant predictors of extubation success.
- Infants in the extubation failure group had lower GA and birth weight (BW).
- Infants in the extubation success group had higher weight at extubation and lower post-extubation PaCO2.
Conclusions:
- GA and post-extubation PaCO2 are critical predictors for successful extubation in VLBW and ELBW preterm infants.
- Extubation failure was associated with lower birth weight and higher pre-extubation FiO2.
Background:
Although invasive mechanical ventilation (IMV) has contributed to the survival of preterm infants with extremely low birth weight (ELBW), it is also associated with unsatisfactory clinical outcomes when used for prolonged periods. This study aimed to identify factors that may be decisive for extubation success in very low birth weight (VLBW) and extremely low birth weight (ELBW) preterm infants.
Methods:
The cohort study included preterm infants with gestational age (GA) <36 weeks, birth weight (BW) <1500 grams who underwent IMV, born between 2015 and 2018. The infants were allocated into two groups: extubation success (SG) or failure (FG). A stepwise logistic regression model was created to determine variables associated with successful extubation.
Results:
Eighty-three preterm infants were included. GA and post-extubation arterial partial pressure of carbon dioxide (PaCO2) were predictive of extubation success. Infants from FG had lower GA and BW, while those from SG had higher weight at extubation and lower post-extubation PaCO2.
Discussion:
Although we found post-extubation PaCO2 as an extubation success predictor, which is a variable representative of the moment after the primary outcome, this does not diminish its clinical relevance since extubation does not implicate in ET removal only; it also involves all the aspects that take place within a specified period (72 hours) after the planned event.
Conclusion:
GA and post-extubation PaCO2 were predictors for extubation success in VLBW and ELBW preterm infants. Infants who experienced extubation failure had lower birth weight and higher FiO2 prior to extubation.
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