Original ArticleExtubating Extremely Preterm Infants: Predictors of Success and Outcomes following Failure
Section snippets
Methods
Between 2010-2012, we performed a multicenter, randomized controlled trial comparing high-flow nasal cannula (HFNC) with starting gas flow 5-6 L per minute, depending on the prong size used, with nasal continuous positive airway pressure (CPAP) 7 cm of water (cm H2O) as postextubation support for very preterm infants.17 The trial was designed and conducted by the authors. The human research ethics committee at each center approved the trial. Infants were eligible if they were born <32 weeks GA,
Results
Of the 303 infants included in the randomized trial (recruited May 31, 2010, to July 3, 2012), 174 were extremely preterm and eligible for this analysis. Of these, 4 (2%) were born at 23 weeks GA, 31 (18%) at 24 weeks, 28 (16%) at 25 weeks, 54 (31%) at 26 weeks, and 57 (33%) at 27 weeks (Table I). Of the 174 extremely preterm infants, 118 (68%) infants were successfully extubated, and 56 (32%) had extubation failure. The reasons for extubation failure (more than 1 reason could be given) were
Discussion
In a cohort of extremely preterm infants who participated in a randomized trial, higher GA and lower pre-extubation PCO2 predicted extubation success. The area under a receiver operator characteristic curve for a model combining these 2 predictive variables was 0.81, indicating that on average those who failed extubation would have a more abnormal test result using this model than 81% of those who did not fail extubation. Infants in our cohort who had extubation failure were more likely to die
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Funded by the National Health and Medical Research Council (606789). The authors declare no conflicts of interest.