Predictors of successful extubation of preterm low-birth-weight infants with respiratory distress syndrome

Marta Szymankiewicz, Dharmapuri Vidyasagar, Janusz Gadzinowski
Pediatric Critical Care Medicine 2005, 6 (1): 44-9

OBJECTIVE: The aim of the study was to measure pulmonary mechanics in infants with respiratory distress syndrome before extubation and to correlate pulmonary function values with successful extubation.

DESIGN: Clinical study.

SETTING: Neonatal intensive care unit.

PATIENTS: Fifty-one infants (birth weight, 1158.6 +/- 150.6 g; gestational age, 29.1 +/- 2.0 wks).

INTERVENTIONS: Ventilation and daily ventilatory management.

MEASUREMENTS AND MAIN RESULTS: Of the 51 infants studied, 35 (60.8%) were successfully extubated, whereas 16 (39.2%) required reintubation and mechanical ventilation within 72 hrs after extubation. All patients met the clinical and biochemical criteria for extubation. Variables of artificial ventilation before extubation were minimal in all the studied cases (Fio(2) </=0.4, inspiratory pressure </=20 cm H(2)O, ventilatory rate, </=10/min). Pulmonary mechanics were measured before extubation using a noninvasive, mobile VenTrak measuring station.

RESULTS: Significant differences in pulmonary function values between the groups were found. Lower resistance of airways and work of breathing and higher dynamic compliance, tidal volume, and minute ventilation before extubation were associated with successful extubation.

CONCLUSION: On the average, tidal volume values of >6 mL/kg, minute ventilation of >309 mL/kg/min, work of breathing of <0.172 J/L, dynamic compliance of >/=1 mL/cm H(2)O/kg, and resistance of airways of </=176 cm H(2)O/L/sec predicted successful extubation. We recommend measurement of pulmonary function as an assessment tool in determining readiness for extubation.

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