title: Compliance of the respiratory system as a predictor for successful extubation in very-low-birth-weight infants recovering from respiratory distress syndrome.
abstract: OBJECTIVE
  To develop additional criteria to predict for successful extubation of very-low-birth-weight infants recovering from respiratory distress syndrome.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Neonatal intensive care unit at a university teaching hospital.
  
  
  METHODS
  Infants ready for extubation according to clinical, ventilatory and blood gas criteria were studied. Before extubation, tidal volume (Vt), minute ventilation, respiratory rate/Vt and mean inspiratory flow were measured during two different ventilatory settings: (i) during intermittent mandatory ventilation (IMV); and (ii) while breathing spontaneously with endotracheal continuous positive airway pressure (CPAP). Tidal volume was obtained through electronically integrated flow measured by a hot-wire anemometer. Total respiratory compliance (Crs) was determined during IMV and was derived from the formula Vt/PIP-PEEP, where the difference between peak inspiratory pressure (PIP) and positive end-expiratory pressure (PEEP) represented the ventilator inflation pressure.
  
  
  RESULTS
  Each of 49 infants was studied once before extubation. 33 infants (67%) were successfully extubated and 16 (32.6%) required reintubation. Infants in the success and failure groups were matched for gestation, post-conceptional age, study weight and methylxanthine therapy at the time of study. Successful extubation was associated with a higher mean absolute Crs value (ml/cm H2O) specific Crs value (standardised for body length; ml/cm H2O/cm) compared with infants in whom extubation failed (0.67 v. 0.46; P = 0.01 and 0.018 v. 0.014; P = 0.03, respectively). Analysis of ROC curves detected thresholds for Crs (0.5 ml/cm H2O) and Vt (7 ml) for predicting successful extubation. An absolute Crs value 0.5 ml/cm H2O or more improved the likelihood of successful extubation when compared with clinical/ventilator and blood gas criteria. The likelihood of successful extubation was 81% if the Crs value was > or = 0.5 ml/cm H2O. A tidal volume of 7 ml or more was less sensitive in contributing to successful extubation (sensitivity 69%). The major causes for extubation failure included atelectasis (diffuse and/or localised) and the presence of a patent ductus arteriosus.
  
  
  CONCLUSIONS
  In addition to following very precise ventilatory criteria for extubation, we found that bedside measurement of total respiratory system compliance added to the likelihood of extubation success in infants recovering from respiratory distress syndrome. Prospective studies are needed to validate the findings of this study.
authors.affiliation: Department of Paediatrics and Child Health and Respiratory Technology, University of Stellenbosch, W Cape.
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.forename: C H
authors.initials: CH
authors.lastname: Pieper
authors.forename: D
authors.initials: D
authors.lastname: Maree
authors.forename: R P
authors.initials: RP
authors.lastname: Gie
mesh_terms: D000628:Aminophylline / Q000627:therapeutic use; D001784:Blood Gas Analysis; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003627:Data Interpretation, Statistical; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000097:blood; D008170:Lung Compliance / Q000187:drug effects; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D013990:Tidal Volume / Q000187:drug effects; D015300:Ventilator Weaning; D014970:Xanthines / Q000627:therapeutic use
chemical_list: D001993:Bronchodilator Agents; D014970:Xanthines; D000628:Aminophylline; C008514:methylxanthine