Application of nasal continuous positive airway pressure to early extubation in very low birthweight infants.

Using a preset protocol for early extubation, 50 babies were randomly selected to post-extubation headbox or post-extubation nasal continuous positive airway pressure (N-CPAP). All infants weighed less than 1500 g, had a gestational age of less than 34 weeks, and had been weaning from mechanical ventilation within seven days of life. The criteria for extubation included stable condition, fraction of inspired oxygen (FIO2) of < or = 35%, peak inspiratory pressure (PIP) of < or = 15 cm H2O (1.47 kPa), and ventilator rate of 6/minute. Before extubation, a loading dose of aminophylline was given followed by maintenance treatment. If reintubation was not required within 72 hours of the initial extubation the procedure was considered successful. The reintubation criteria included FIO2 > or = 70% to maintain arterial oxygen tension (PaO2) of > or = 50 mm Hg (6.67 kPa) or pulse oximetry between 90-96% and pH of < 7.25, and arterial carbon dioxide tension (PACO2) of > 60 mm Hg (8.00 kPa) and severe or recurring apnoea. The overall success rate of early extubation was 66% (33/50). The individual successful extubation rate of post-extubation in the N-CPAP group and the post-extubation headbox group were 84% (21/25) and 48% (12/25), respectively (p = 0.017; chi 2). There were no significant differences in clinical characteristics between the two groups. The most common cause of failure in early extubation was apnoea, and most occurred in the headbox group (9/12). These results suggest that application of N-CPAP to a preset protocol for extubation can achieve a better success rate of early extubation in very low birthweight (VLBW) infants.