[Prediction of extubation failure in ELBW preterm infants].
BACKGROUND
The accurately timed extubation of ventilated ELBW preterm infants is still a problem. With different data systems the attempt has been made to more accurately predict the successful extubation of these infants. However, there do not yet exist any satisfying solutions.


METHODS
We retrospectively analysed 66 ELBW preterm infants who were endotracheal intubated and ventilated within 24 h postnatal. Basic data, clinical and ventilation data immediately before planned extubation and in several intervals during the following 24 h, as well as outcome variables at discharge were interpreted.


RESULTS
51 patients were successfully extubated (EE-group), 15 (22.7%) failed extubation (reintubation within 48 h after extubation, EV-group). Immediately before extubation in the EE-group there was found a significantly higher inspiratory oxygen concentration (FiO2) in comparison to the EV-group (0.25 vs. 0.3; p=0.01). After the extubation attempt the inspiratory oxygen concentration stayed lower in the EE-group, whereas in the EV-group it rose remarkably (2 h after ext.: 0.26 vs. 0.4; p<0.001). Neither of the basic data showed any significant difference. The outcome analysis indicated a longer intensive care in the EV-group and a trend towards increased BPD and ROP.


CONCLUSIONS
The study shows that for ELBW preterm infants the inspiratory oxygen concentration is especially important to predict a successful extubation. According to our data, the inspiratory oxygen demand before and immediately after extubation establishes the essential difference between successfully extubated and reintubated infants.
Neonatologie, Universitätsklinikum Leipzig-Klinikum für Kinder- und Jugendmedizin, Leipzig. julia@vonmerkel.de
J
J
von Merkel
C
C
Gebauer
A
A
Bläser
F
F
Pulzer
U
U
Thome
M
M
Knüpfer
D060666:Airway Extubation; D001049:Apnea / Q000097:blood / Q000628:therapy; D005260:Female; D005858:Germany; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D001239:Inhalation / Q000502:physiology; D008297:Male; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood / Q000628:therapy*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D015300:Ventilator Weaning
D011663:Pulmonary Surfactants; D010100:Oxygen