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. 2022 May;22(2):247-252.
doi: 10.18295/squmj.8.2021.122. Epub 2022 May 26.

Risk Factors of Extubation Failure in Intubated Preterm Infants at a Tertiary Care Hospital in Oman

Hilal Al Mandhari  1 , Buthina Al Riyami  2 , Ashfaq Khan  1 , Mika Nonoyama  3   4 , Syed G A Rizvi  5
Affiliations

Risk Factors of Extubation Failure in Intubated Preterm Infants at a Tertiary Care Hospital in Oman

Hilal Al Mandhari et al. Sultan Qaboos Univ Med J. 2022 May.

Abstract

Objectives: This study aimed to determine extubation failure (EF) rate among intubated preterm infants (<37 weeks gestational age [GA]) admitted to a tertiary care neonatal intensive care unit (NICU) in Oman and identify the risk factors associated with EF.

Methods: This retrospective study included all intubated preterm infants (<37 weeks GA) admitted to the NICU at Sultan Qaboos University Hospital (SQUH) from January 2013 to December 2017. EF was defined as reintubation within seven days of planned extubation. Demographics, ventilation parameters, blood gas values and other possible risk factors of EF were collected. Statistical analysis included comparisons between EF and extubation success (ES) groups and a binary logistic regression analysis.

Results: A total of 190 preterm infants were intubated during the study period with 140 eligible for analysis. A total of 106 infants (75.7%) were successfully extubated while 34 (24.3%) failed extubation. GA <28 weeks (P = 0.029), lower 1-minute Apgar score (P = 0.023) and patent ductus arteriosus diagnosis (P = 0.018) were significantly associated with EF. After the multivariate analysis, only GA <28 weeks predicted EF with an adjusted odds ratio of 2.621 (95% confidence interval: 1.118 - 6.146).

Conclusion: EF rate in preterm infants admitted at the NICU of SQUH was within international rates. GA <28 weeks was the only predictor of the identified extubation failure. Neonatal practitioners need to seriously consider extreme prematurity in the extubation process and consider implementing strategies to decrease extubation failure in this group of fragile infants.

Keywords: Airway extubation; Neonate; Oman; Premature Infants; Risk Factors.

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Conflict of interest statement

CONFLICT OF INTEREST The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart showing the study population selection.
Figure 2
Figure 2
Reported reason for reintubation of infants in the neonatal intensive care unit (n = 34).
Figure 3
Figure 3
Cumulative extubation failure per day of infants in the neonatal intensive care unit (n = 34).
See this image and copyright information in PMC

References

    1. Stefanescu BM, Murphy WP, Hansell BJ, Fuloria M, Morgan TM, Aschner JL. A randomized, controlled trial comparing two different continuous positive airway pressure systems for the successful extubation of extremely low birth weight infants. Pediatrics. 2003;112:1031–8. doi: 10.1542/peds.112.5.1031. - DOI - PubMed
    1. Al-Mandari H, Shalish W, Dempsey E, Keszler M, Davis PG, Sant'Anna G. International survey on periextubation practices in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. 2015;100:F428–31. doi: 10.1136/archdischild-2015-308549. - DOI - PubMed
    1. Miller JD, Carlo WA. Pulmonary complications of mechanical ventilation in neonates. Clin Perinatol. 2008;35:273–81. x–xi. doi: 10.1016/j.clp.2007.11.004. - DOI - PubMed
    1. Kamlin CO, Davis PG, Morley CJ. Predicting successful extubation of very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2006;91:F180–3. doi: 10.1136/adc.2005.081083. - DOI - PMC - PubMed
    1. Baisch SD, Wheeler WB, Kurachek SC, Cornfield DN. Extubation failure in pediatric intensive care incidence and outcomes. Pediatr Crit Care Med. 2005;6:312–18. doi: 10.1097/01.PCC.0000161119.05076.91. - DOI - PubMed

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