Extubation from high-frequency oscillatory ventilation in extremely low birth weight infants: a prospective observational study. Issue 1 (9th November 2018)

• Record Type: Journal Article
• Authors: Tana, Milena; Lio, Alessandra; Tirone, Chiara; Aurilia, Claudia; Tiberi, Eloisa; Serrao, Francesca; Purcaro, Velia; Corsello, Mirta; Catenazzi, Piero; D'Andrea, Vito; Barone, Giovanni; Ricci, Cinzia; Pastorino, Roberta; Vento, Giovanni
• Is Part Of: BMJ paediatrics open. Volume 2:Issue 1(2018)
• Publication Date: 2018-11-09
• Subjects: HFOV -- extubation criteria -- ELBW infants -- respiratory distress syndrome -- mean airway pressure; Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.920005
• DOI: 10.1136/bmjpo-2018-000350
• Languages: English
• ISSNs: 2399-9772

Abstract

Abstract : Objective: To evaluate if weaning from high-frequency oscillatory ventilation (HFOV) directly to a non-invasive mode of respiratory support is feasible and results in successful extubation in extremely low birth weight (ELBW) infants. Design: Prospective observational study. Setting: Tertiary neonatal intensive care unit. Patients: One hundred and eight ELBW infants of 26.2±1.4 weeks of gestational age (GA) directly extubated from HFOV. Interventions: All infants were managed with elective HFOV and received surfactant after a recruitment HFOV manoeuvre. Extubation was attempted at mean airways pressure (MAP) ≤6 cm H2 O with FiO2 ≤0.25. After extubation, all infants were supported by nasal continuous positive airway pressure (6–8 cm H2 O). Main outcome measures: Extubation failure (clinical deterioration requiring reintubation) was defined as shorter than 7 days. Results: Ninety patients (83%) were successfully extubated and 18 (17%) required reintubation. No significant differences were found between the two groups in terms of birth weight, day of life and weight at the time of extubation. Multivariable analysis showed that GA (OR 1.71; 95% CI 1.04, 2.08) and higher MAP prior to surfactant (OR 1.51; 95% CI 1.06, 2.15) were associated with successful extubation. Conclusions: In ELBW infants, direct extubation from HFOV at MAP ≤6 cm H2 O with FiO2 ≤0.25 is feasible. Our extubation success rate (83%) is higher than conventional mechanical ventilation in this very vulnerable class of infants.