Department for Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
BMJ Paediatr Open. 2022 Aug;6(1). doi: 10.1136/bmjpo-2022-001542.
The aim of the study was to investigate first extubation attempts among extremely premature (EP) infants and to explore factors that may increase the quality of clinical judgement of extubation readiness.
A population-based study was conducted to explore first extubation attempts for EP infants born before a gestational age (GA) of 26 weeks in Norway between 1 January 2013 and 31 December 2018. Eligible infants were identified via the Norwegian Neonatal Network database. The primary outcome was successful extubation, defined as no reintubation within 72 hours after extubation.
Among 482 eligible infants, 316 first extubation attempts were identified. Overall, 173 (55%) infants were successfully extubated, whereas the first attempt failed in 143 (45%) infants. A total of 261 (83%) infants were extubated from conventional ventilation (CV), and 55 (17%) infants were extubated from high-frequency oscillatory ventilation (HFOV). In extubation from CV, pre-extubation fraction of inspired oxygen (FiO) ≤0.35, higher Apgar score, higher GA, female sex and higher postnatal age were important predictors of successful extubation. In extubation from HFOV, a pre-extubation FiO level ≤0.35 was a relevant predictor of successful extubation.
The correct timing of extubation in EP infants is important. In this national cohort, 55% of the first extubation attempts were successful. Our results suggest that additional emphasis on oxygen requirement, sex and general condition at birth may further increase extubation success when clinicians are about to extubate EP infants for the first time.
本研究旨在调查极早产儿（EP）的首次拔管尝试，并探讨可能提高临床拔管准备判断质量的因素。
本研究为基于人群的研究，旨在探讨 2013 年 1 月 1 日至 2018 年 12 月 31 日期间在挪威出生的胎龄（GA）<26 周的 EP 婴儿的首次拔管尝试。通过挪威新生儿网络数据库识别符合条件的婴儿。主要结局为成功拔管，定义为拔管后 72 小时内无再次插管。
在 482 名符合条件的婴儿中，确定了 316 次首次拔管尝试。总体而言，173 名（55%）婴儿成功拔管，而 143 名（45%）婴儿首次尝试失败。共有 261 名（83%）婴儿从常规通气（CV）中拔管，55 名（17%）婴儿从高频振荡通气（HFOV）中拔管。在 CV 拔管中，拔管前吸入氧分数（FiO）≤0.35、较高的 Apgar 评分、较高的 GA、女性和较高的出生后年龄是成功拔管的重要预测因素。在 HFOV 拔管中，拔管前 FiO 水平≤0.35是成功拔管的相关预测因素。
EP 婴儿拔管的正确时机很重要。在本国家队列中，首次拔管尝试的成功率为 55%。我们的结果表明，当临床医生首次准备为 EP 婴儿拔管时，进一步强调氧需求、性别和出生时的一般情况可能会进一步提高拔管成功率。
