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Predictors of successful extubation from volume-targeted ventilation in extremely preterm neonates

Journal of Perinatology volume 44, pages 250–256 (2024)Cite this article

Subjects

Abstract

Objective

To identify variables associated with extubation success in extremely preterm neonates extubated from invasive volume-targeted ventilation.

Study design

We retrospectively evaluated 84 neonates ≤28 weeks’ gestational age, on their first elective extubation. The primary outcome of successful extubation was defined as non-reintubation within seven days. We used multivariate logistic regression analysis.

Results

We identified 58 (69%) neonates (mean gestational age of 26.5 ± 1.4 weeks, birthweight 921 ± 217 g) who met the primary outcome. Female sex (OR 1.15, 95% CI 1.01–9.10), higher pre-extubation weight (OR 1.29, 95% CI 1.05–1.59), and pH (OR 2.54, 95% CI 1.54–4.19), and lower pre-extubation mean airway pressure (MAP) (OR 0.49, 95% CI 0.33–0.73) were associated with successful extubation.

Conclusions

In preterm neonates, female sex, higher pre-extubation weight and pH, and lower pre-extubation MAP were predictors of successful extubation from volume-targeted ventilation. Evaluation of these variables will likely assist clinicians in selecting the optimal time for extubation in such vulnerable neonates.

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Authors and Affiliations

  1. Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Dimitrios Rallis, Danielle Ben-David, Kendra Woo, Jill Robinson, David Beadles, Fotios Spyropoulos, Helen Christou & Sule Cataltepe

  2. Neonatal Intensive Care Unit, University of Ioannina, Faculty of Medicine, Ioannina, Greece

    Dimitrios Rallis

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Contributions

D.R. designed the study, collected data, carried out the initial analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript. D.B.D., and K.W. designed the data collection instruments, collected data, and critically reviewed and revised the manuscript. J.R., D.B., F.S., and H.C. critically reviewed and revised the manuscript. S.C. conceptualized and designed the study, coordinated, and supervised data collection, and critically reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Dimitrios Rallis.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by the institutional review board (Protocol Number 2023P001168/05.05.2023). The study was performed in accordance with the Declaration of Helsinki.

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Rallis, D., Ben-David, D., Woo, K. et al. Predictors of successful extubation from volume-targeted ventilation in extremely preterm neonates. J Perinatol 44, 250–256 (2024). https://doi.org/10.1038/s41372-023-01849-4

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