title: Failed extubation in the neonatal intensive care unit.
abstract: One of the roles of the pediatric otolaryngologist in the neonatal intensive care unit (NICU) is the assessment and management of the neonate who fails a trial of extubation. This paper reviews the recent 5-year institutional experience at The Hospital for Sick Children, Toronto, with neonates who failed extubation and who subsequently underwent diagnostic endoscopy. One hundred twenty-eight neonates from the NICU underwent diagnostic endoscopy. Of these, 58 neonates underwent diagnostic endoscopy for failure to extubate. Nine neonates were extubated after diagnostic endoscopy and retrial (16% of the series). Eleven neonates were extubated after additional endoscopic procedures (19% of the series). Twenty-four neonates underwent anterior cricoid split, of whom 20 or 83% (34% of the series) were eventually successfully extubated with no further airway intervention required during the study period (minimum 6 months' follow-up). Eleven neonates underwent tracheotomy (19% of the series). Four neonates underwent another external procedure to allow extubation (7% of the series). Three neonates died while still intubated (5% of the series). Our management of the neonate who fails a trial of extubation is discussed.
authors.affiliation: Department of Otolaryngology, Hospital for Sick Children, University of Toronto, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Walker
authors.forename: V
authors.initials: V
authors.lastname: Forte
mesh_terms: D002985:Clinical Protocols; D003131:Combined Modality Therapy; D003413:Cricoid Cartilage / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D007828:Laryngoscopy; D008297:Male; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014140:Tracheotomy; D017211:Treatment Failure