The Optimal Predictors of Readiness for Extubation in Low Birth Weight Infants.

Background: Reintubation, following an unsuccessful extubation from mechanical ventilation is traumatic to the infant and the family. However, 20 to 40% of infants fail extubation and reintubation.

Objective: Determine the optimal predictors of readiness for extubation in low birth weight infants during endotracheal tubecontinuous positive airway pressure (ET CPAP) for three minutes. The primary outcome was reintubation within 72 hours of extubation and the secondary outcomes were the causes and risk factors of reintubation.

Material and Method: A prospective cohort study was undertaken in 51 mechanically ventilated infants who were considered to be ready for extubation. The infants were changed to ET CPAP for a 3-minute spontaneous breathing test (SBT) before extubated. Infants were divided into two groups based upon whether they failed or passed the extubation attempt. Extubation failure was defined as reintubation within 72 hours of extubatio

Results: Forty-five of 51 infants (88%) were successfully extubated. Out of the 51 infants only one infant failed the SBT. The three predictors of extubation success that included the SBT, ratio of minute ventilation during ET CPAP to mechanical ventilation and ratio of respiratory frequency during ET CPAP to mechanical ventilation were not significantly different. Using synchronized nasal intermittent positive pressure ventilation after extubation in the failed extubation group was significantly higher than the successful extubation group (66.7% vs. 15.7%, p = 0.02).

Conclusion: The SBT and minute ventilation ratio in low birth weight infants were not optimal predictors of readiness for extubation. However, a further prospective study in this field with a larger number of subjects and a proper indication for extubation should be considered.