Predictors of Extubation Failure in Mechanically Ventilated Neonates in the NICU

Marie Shalini Chico, Saudamini Nesargi, Suman Rao PN, Ashok Chandrasekaran, Swarnarekha Bhat

Abstract

Background and Aim: In the present scenario of healthcare, mechanical ventilation plays a large role in the treatment of neonates to prevent morbidity and mortality. A significant number of term and preterm neonates require reventilation after extubation. There are insufficient guidelines for the assessment of readiness of patients for extubation, though several studies have been done on the same. 

The aim of the study was to determine the predictors of extubation failure in term and preterm neonates with respect to clinical, laboratory, and pulmonary mechanics.

Materials and Methods: In this prospective observational study, 51 neonates requiring invasive ventilation for > 12 hours were analyzed. During the period of ventilation, their maximum ventilatory requirements were noted. Extubation failure was defined as requirement for reintubation within 48 hours of extubation. Prior to extubation, some key clinical, laboratory, and pulmonary mechanics parameters were assessed and values were noted. The differences in variables between the successfully and unsuccessfully extubated neonates were analyzed by Student t test and Χ2 test.

Results: Of the 51 neonates studied, 41 (80.4%) neonates passed extubation and 10 (19.6%) required reintubation within 48 hours of extubation. There were no significant differences between the 2 groups with respect to clinical characteristics, maximum ventilator requirements, or laboratory parameters. Pulmonary mechanics were studied in 27 of 51 neonates. There was no significant difference in the tidal volume and compliance between the groups. Minute ventilation, however, was significantly higher in those who failed extubation (P = .002).

Conclusion: Minute ventilation may serve as an objective indicator of readiness for extubation in neonates.

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