Respiratory Setback Associated with Extubation Failure in Extremely
Preterm Infants
Abstract
Background and Objectives: Extubation failure in preterm infants is
associated with increased risk of mortality and morbidities. There is
limited evidence to suggest if the increased morbidities are due to
inherent differences among infants who fail or succeed; or whether these
are due to a true respiratory setback among those who fail extubation.
The aim of this study was to evaluate the respiratory status of infants
who fail extubation and to assess the time taken for these infants to
achieve pre-extubation respiratory status. Methods: This was a
retrospective study of infants with birth weight ≤1,250 g who were born
between January 2009 and December 2016. Infants were eligible if they
failed first elective extubation. Extubation failure was defined as need
for re-intubation within 5 days of extubation. Ventilator settings,
blood gas parameters, respiratory severity score and ventilation index
were used to assess respiratory status of infants. Results: Of 384
infants, 76% were successful and 24% failed extubation. Among those
who failed extubation 91%, 77% and 56% infants remained intubated at
24 hours, 72 hours and 7 days, respectively. Respiratory status was
worse at 24 hours and 72 hours after re-intubation when compared to
pre-extubation levels. The median times for respiratory severity score
and ventilation index to reach pre-extubation levels were 4 days and 7
days respectively. Conclusion: Among preterm infants, failed elective
extubation is associated with a significant setback in the respiratory
status. Infants who fail an extubation attempt may not achieve
pre-extubation respiratory status for many days after reintubation.