Feasibility of weaning and direct extubation from open lung high-frequency ventilation in preterm infants.
OBJECTIVE
High-frequency ventilation (HFV) is increasingly used in preterm infants, but data on weaning and extubation are limited. We aimed to establish if weaning the continuous distending pressure (CDP) below 8 cm H2O and the Fio2 below 0.30 is feasible in preterm infants on open lung HFV and if these settings result in successful extubation.


METHODS
Retrospective cohort study.


METHODS
Neonatal intensive care unit in a university hospital.


METHODS
Preterm infants ventilated and directly extubated from HFV between January 2003 and August 2005.


RESULTS
Data on patient characteristics, ventilator settings, gas exchange, respiratory support after extubation and the number of patients failing extubation (i.e., reintubation within 48 hr) were retrospectively collected. Two hundred fourteen infants, accounting for 242 ventilation periods, were included in the study. The CDP, but not the Fio2, decreased significantly in the 24-hr period before extubation, resulting in a mean CDP of 6.8 +/- 1.6 cm H2O and a mean Fio2 of 0.25 at the time of extubation. At these settings, 193 (90%) infants were successfully extubated. Multivariate logistic regression analysis showed that birth weight was the only independent variable positively associated with successful extubation.


CONCLUSIONS
This study shows that weaning the CDP below 8 cm H2O with an Fio2 below 0.30 is feasible during open lung HFV and extubation at these settings can be successful in preterm infants. In our series, a 90% success rate was observed. The value of this approach should be prospectively compared with conventional weaning and extubation strategies.
van Velzen
Alice
A
Department of Neonatology, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
De Jaegere
Anne
A
van der Lee
Johanna
J
van Kaam
Anton
A
D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood; D015331:Cohort Studies; D020878:Device Removal; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006612:High-Frequency Ventilation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011659:Pulmonary Gas Exchange; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015656:Respiratory Mechanics / Q000502:physiology; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*
D002245:Carbon Dioxide