Am J Perinatol 2020; 37(02): 204-209
DOI: 10.1055/s-0039-1696714
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tidal Volumes and Outcome of Extubation in Mechanically Ventilated Premature Infants

1   Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
2   Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
,
Emma Williams
3   Neonatal Intensive Care Unit, St George's University Hospitals, London, United Kingdom
,
Hemant Ambulkar
1   Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
Sandeep Shetty
3   Neonatal Intensive Care Unit, St George's University Hospitals, London, United Kingdom
,
Ann Hickey
1   Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
,
2   Department of Women & Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
4   MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, United Kingdom
5   National Institute for Health Research Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
› Author Affiliations
Funding This research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.
Further Information

Publication History

31 May 2019

26 July 2019

Publication Date:
06 September 2019 (online)

Abstract

Objectives To compare the adjusted and unadjusted-for-weight tidal volume (VT) in ventilated prematurely born infants who were successfully extubated compared with the ones who failed extubation and explore the ability of VT to predict successful extubation.

Study Design This is a two-center, prospective, observational, cohort study of ventilated infants born <32 weeks of gestational age (GA) at King's College Hospital and St George's University Hospital, London, United Kingdom between February and September 2018. Expiratory VT was recorded before extubation, and extubation was considered successful if the infants were not reintubated within 72 hours.

Results Fifty-six (29 male) infants with a median (interquartile range) GA of 26 (25–29) weeks were studied. The infants who successfully extubated (N = 36) had a higher GA (27 [25–30] weeks) and VT (7.2 [4.8–9.5] mL) compared with the GA (25 [24–26] weeks) and VT (4.3 [4.0–5.5] mL) of the infants who failed extubation (p = 0.002 and p = 0.001, respectively). VT/kg was not different in infants who successfully extubated compared with the ones who failed extubation (p = 0.643). Following multivariate regression, VT was associated with extubation success (adjusted p = 0.022) and GA was not (adjusted p = 0.167). A VT > 4.5 mL predicted successful extubation with 82% sensitivity and 58% specificity (area under the curve = 0.786).

Conclusion Successful extubation was associated with higher unadjusted-for-weight VTs compared with failed extubation, and unadjusted VT predicted extubation outcome with moderate sensitivity and specificity.

 
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