Predicting successful extubation of very low birth weight infants

C. Omar Farouk Kamlin ^1*, Peter G Davis ² and Colin J Morley ³

¹ Royal Women's Hospital, Melbourne, Australia
² Royal Women's Hospital and University of Melbourne, Australia
³ Royal Women's Hospital and Murdoch Research Institute, Australia

^* To whom correspondence should be addressed. E-mail: omar.kamlin{at}rwh.org.au.

Accepted 16 December 2005

Abstract

Objective To determine the accuracy of three tests used to predict successful extubation of preterm infants.

Study design Mechanically ventilated infants with birth weight <1250g and considered ready for extubation were changed to endotracheal continuous positive airway pressure (ET CPAP) for 3 minutes. Tidal volumes, minute ventilation, heart rate and oxygen saturation were recorded before and during ET CPAP. We evaluated three tests of extubation success: (i) expired minute ventilation (V'E) during ET CPAP, (ii) ratio of minute volume during ET CPAP to minute volume during mechanical ventilation (V'E ratio) and (iii) the "spontaneous breathing test" (SBT); the infant passed this test if there was no hypoxia or bradycardia during ET CPAP. The clinical team were masked to the results and infants were extubated. Extubation failure was defined as re- intubation within 72 hours of extubation.

Results 50 infants were studied and extubated. 11 (22%) were re-intubated. The SBT was the most accurate of the 3 tests with a sensitivity of 97% and specificity of 73% and a positive and negative predictive value for extubation success of 93% and 89% respectively.

Conclusion The SBT used just prior to extubation of infants <1250g may reduce the number of extubation failures. Further studies are required to establish whether the SBT may be used as the primary determinant of infants' readiness for extubation.

Keywords: extubation, infant, newborn, positive pressure respiration, respiratory function test

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