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Published on: August 2, 2024
Postmenstrual age at Extubation as a Risk Factor Associated With Respiratory-Related Reintubation Among Extremely
Masanori Kambara1, Jiro Takeuchi2, Akari Kumano1
1Department of Pediatrics, Aizenbashi Hospital, Osaka, Japan.
Insights
Extubation failure in extremely preterm infants is linked to pre-extubation carbon dioxide levels, oxygen concentration, and postmenstrual age. Longer observation periods are crucial for accurate assessment of extubation readiness.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Previous studies may have underestimated extubation failure in preterm infants due to limited observation windows.
- Accurate identification of risk factors for extubation failure is critical for improving outcomes in extremely preterm infants.
Purpose of the Study:
- To identify risk factors associated with reintubation in extremely preterm infants during hospitalization.
- To improve the assessment of extubation readiness in this vulnerable population.
Main Methods:
- A single-center, retrospective cohort study.
- Inclusion of infants born before 28 weeks gestational age between 2018 and 2022.
- Multivariable logistic regression analysis to assess risk factors for respiratory-related extubation failure.
Main Results:
- 34.7% of 95 extremely preterm infants experienced extubation failure.
- Key risk factors identified: pre-extubation partial pressure of carbon dioxide (PCO2), fraction of inspired oxygen (FiO2), and postmenstrual age (PMA) at extubation.
- A predictive model incorporating these factors showed an area under the curve of 0.802.
Conclusions:
- Accurate assessment of extubation failure requires a longer observation period.
- Both respiratory status before extubation and postmenstrual age are important considerations for determining extubation readiness.
- These findings can inform clinical practice to reduce reintubation rates in extremely preterm infants.
Background:
Previous studies that discussed risk factors associated with extubation failure among preterm infants may have underestimated extubation failures because they used short observation windows for detecting reintubations.
Aims:
To explore risk factors associated with reintubations among extremely preterm infants during hospitalization.
Study Design:
A single-center, retrospective cohort study.
Subjects:
Infants born < 28 weeks gestational age between January 1, 2018, and December 31, 2022.
Outcome Measures:
We focused only on extubation failures associated with respiratory problems. We assessed risk factors by conducting multivariable logistic regression analyses using variables previously reported as risk factors associated with extubation failure among preterm infants.
Results:
Ninety-five infants with a median gestational age of 25.6 weeks were eligible, and of those, 33 infants (34.7%) experienced extubation failure. Reintubations within 7 days after extubation accounted for approximately three-quarters of whole reintubations (24 infants, 72.7%). Risk factors associated with extubation failure were partial pressure of carbon dioxide (PCO2) before extubation (adjusted odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.14; p = 0.023), fraction of inspired oxygen (FIO2) before extubation (adjusted OR, 2.97; 95% CI, 1.10-8.04; p = 0.032), and postmenstrual age (PMA) at extubation (adjusted OR, 0.90; 95% CI, 0.84-0.97; p = 0.004). The predictive model submitting these variables demonstrated an area under the curve of 0.802.
Conclusions:
When evaluating extubation failures more precisely by adopting the longer period, we might need to consider not only respiratory status before extubation but also maturity at extubation to assess extubation readiness.
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