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 H2O with FiO2 ≤0.25. After extubation, all infants were supported by nasal continuous positive airway pressure (6–8 cm H2O).
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 H2O with FiO2 ≤0.25 is feasible. Our extubation success rate (83%) is higher than conventional mechanical ventilation in this very vulnerable class of infants.
- extubation criteria
- ELBW infants
- respiratory distress syndrome
- mean airway pressure
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Contributors MT designed the study, collected the data, analysed the data and wrote the first and final drafts of the manuscript. AL carried out the data collection and the literature search, assisted with the analysis and provided significant edits to the manuscript. CT and CA carried out the data collection and drafted the initial manuscript. ET carried out the data collection and the initial analyses, reviewed and revised the manuscript. FS, VP, MC and PC carried out the data collection, the literature search, reviewed and revised the manuscript. VD’A, GB and CR carried out the data collection, the literature search, reviewed and made significant edits to the manuscript. RP carried out statistical analysis GV conceptualised and designed the study and critically reviewed the manuscript. All authors read and approved the submission of this version of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval This study was approved by the Ethics Committee of the Department of Pediatrics of Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy—Università Cattolica del Sacro Cuore.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
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