RISK FACTORS FOR EXTUBATION FAILURE IN PRETERM INFANTS
Adhie Nur Radityo,Risma Kerina Kaban
Background : Prolonged mechanical ventilation and endotracheal intubation in preterm infants is associated with both adverse neurodevelopmental outcomes and acute complication. Therefore, extubation of ventilated infants as early as possible is the clinical goal. The optimal timing of extubation in preterm infants remains unclear.
Material : We retrospectively analyzed all preterm infants who were admitted to our neonatal intensive care unit (NICU) from January 2017 to April 2018. Demographic, ventilation and capillary blood gas analysis results prior to extubation were collected. Extubation failure was defined as reintubation due to deterioration of respiratory condition within 7 days after extubation. Risk factors for extubation failure were analyzed.
Results : In total, 225 preterm infants were born and admitted to our NICU during these years. Among these 225 infants, 130 patients that required intubation, 19 patients expired so extubation was not attempted. Fourty of 111 (36%) survival cases required reintubation within 7 days after extubation. We found that gestational age, birth weight and sex ratio did not differ between the successful and the failed extubation group. Univariate analysis showed that the failed extubation group had a higher mean airway pressure (MAP) and capillary pH right before extubation, with sepsis and hemodynamically significant persistent ductus arteriosus (PDA) as other risk factor. Further multivariate logistic regression analysis revealed higher MAP and pH were significant risk factors for extubation failure, with OR 2.56 and 1.87, respectively.
Conclusions : Risk of extubation failure in preterm infants increases significantly with higher MAP and higher capillary pH.