A randomized trial of delayed extubation for the reduction of reintubation in extremely preterm infants.
OBJECTIVE
To compare immediate extubation versus delayed extubation after 36 hr in extremely low-birth weight infants receiving gentle mechanical ventilation and perinatal lung protective interventions. Our hypothesis was that a delayed extubation in this setting would decrease the rate of reintubation. STUDY DESIGN/METHODOLOGY: A prospective, unmasked, randomized, controlled trial to compare immediate extubation and delayed extubation after 36 hr. Optimized ventilation in both groups included continuous tracheal gas insufflation (CTGI), prophylactic surfactant administration, low oxygen saturation target and moderate permissive hypercapnia. Successful extubation for at least 7 days was the primary criterion and ventilatory support requirements until 36 weeks gestational age the main secondary criteria.


METHODS
Eighty-six infants under 28 weeks gestational age in a single neonatal intensive tertiary care unit.


RESULTS
Delayed extubation (1.9 +/- 0.8 days vs. 0.5 +/- 0.7 days) did not improve the rate of successful extubation but had no long-term adverse effects. CTGI and the lung protective strategy we describe resulted in a very gentle ventilation. The rate of survival without bronchopulmonary dysplasia (BPD, defined as any respiratory support at 36 weeks gestational age) was similar in the two groups and remarkably high for the global population (78%) and for the subgroup of infants <1,000 g at birth (75%).


CONCLUSIONS
Adding 36 hr of optimized mechanical ventilation before first extubation does not improve the rate of successful extubation but has no adverse effects.
Danan
Claude
C
Department of Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Creteil, Hôpital Henri Mondor, Creteil, France. claude.danan@chicreteil.fr
Durrmeyer
Xavier
X
Brochard
Laurent
L
Decobert
Fabrice
F
Benani
Mohamed
M
Dassieu
Gilles
G
D001997:Bronchopulmonary Dysplasia / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D045422:Continuous Positive Airway Pressure; D018572:Disease-Free Survival; D005260:Female; D005865:Gestational Age; D006801:Humans; D006935:Hypercapnia; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards; D053208:Kaplan-Meier Estimate; D008297:Male; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012107:Research Design; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019233:Retreatment; D013997:Time Factors; D016896:Treatment Outcome
D011663:Pulmonary Surfactants