Predictors of successful extubation of preterm low-birth-weight infants with respiratory distress syndrome.
OBJECTIVE
The aim of the study was to measure pulmonary mechanics in infants with respiratory distress syndrome before extubation and to correlate pulmonary function values with successful extubation.


METHODS
Clinical study.


METHODS
Neonatal intensive care unit.


METHODS
Fifty-one infants (birth weight, 1158.6 +/- 150.6 g; gestational age, 29.1 +/- 2.0 wks).


METHODS
Ventilation and daily ventilatory management.


RESULTS
Of the 51 infants studied, 35 (60.8%) were successfully extubated, whereas 16 (39.2%) required reintubation and mechanical ventilation within 72 hrs after extubation. All patients met the clinical and biochemical criteria for extubation. Variables of artificial ventilation before extubation were minimal in all the studied cases (Fio(2) </=0.4, inspiratory pressure </=20 cm H(2)O, ventilatory rate, </=10/min). Pulmonary mechanics were measured before extubation using a noninvasive, mobile VenTrak measuring station.


RESULTS
Significant differences in pulmonary function values between the groups were found. Lower resistance of airways and work of breathing and higher dynamic compliance, tidal volume, and minute ventilation before extubation were associated with successful extubation.


CONCLUSIONS
On the average, tidal volume values of >6 mL/kg, minute ventilation of >309 mL/kg/min, work of breathing of <0.172 J/L, dynamic compliance of >/=1 mL/cm H(2)O/kg, and resistance of airways of </=176 cm H(2)O/L/sec predicted successful extubation. We recommend measurement of pulmonary function as an assessment tool in determining readiness for extubation.
Szymankiewicz
Marta
M
Department of Neonatology, University of Medical Sciences, Poznań, Poland.
Vidyasagar
Dharmapuri
D
Gadzinowski
Janusz
J
D000628:Aminophylline / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D016013:Likelihood Functions; D011044:Poland; D011237:Predictive Value of Tests; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology* / Q000628:therapy*; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000502:physiology; D013990:Tidal Volume / Q000187:drug effects; D016896:Treatment Outcome; D015300:Ventilator Weaning; D017725:Ventricular Pressure / Q000502:physiology
D001993:Bronchodilator Agents; D000628:Aminophylline; D003907:Dexamethasone