Unplanned extubation and subsequent trial of noninvasive ventilation in the neonatal intensive care unit.
OBJECTIVE
Unplanned extubation (UE) occurs as an infrequent complication of mechanical ventilation in the neonatal intensive care unit (NICU). Following UE, a trial of noninvasive ventilation (NIV) may be considered if a neonate is showing adequate respiratory effort. This study investigated the success and failure rate of NIV management of neonates experiencing UE.


METHODS
Retrospective single-center study of neonates experiencing UE in the NICU over a 9-year period. Reintubation within 12 hours of a trial of NIV following UE was defined as treatment failure. Short-term respiratory outcomes were analyzed for all infants plus the incidence of bronchopulmonary dysplasia for preterm infants born less than 32 weeks' gestation.


RESULTS
A total of 43 patients were included. Of those, 30 infants were trialed on NIV following UE. Baseline demographics were similar between both the groups except for the oxygen requirement before UE. The NIV was successful in 20 and failed in 10 infants. Infants who failed a trial of the NIV were reintubated between 0.45 and 5.25 hours following UE. Respiratory outcomes in very preterm infants did not differ between groups.


CONCLUSIONS
A trial of NIV may be considered as a treatment option in preterm and term newborns experiencing UE in the NICU.
Department of Paediatrics, Mercy Hospital for Women, Melbourne, Australia.
Gemma
G
Nesbitt
Department of Paediatrics, Mercy Hospital for Women, Melbourne, Australia.
Katelyn J
KJ
Guy
Department of Paediatrics, Mercy Hospital for Women, Melbourne, Australia.
Kai
K
König
D001997:Bronchopulmonary Dysplasia / Q000628:therapy*; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D063087:Noninvasive Ventilation / Q000379:methods*; D010100:Oxygen / Q000627:therapeutic use; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D017211:Treatment Failure
D010100:Oxygen