Predicting successful extubation in very preterm infants: A case–control study on key respiratory and clinical predictors
Background: Respiratory failure requiring mechanical ventilation (MV) is a significant challenge for preterm infants, particularly those born before 29 weeks of gestation. Prolonged MV is associated with adverse respiratory and neurodevelopmental outcomes. Extubation failure (EF) remains common, wit...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-07-01
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| Series: | Advances in Biomedical and Health Sciences |
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| Online Access: | https://journals.lww.com/10.4103/abhs.abhs_7_25 |
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| author | Khalid Altirkawi Alwalid Alteraif Abobaker Alshathli Khalid Almoosa Turki Alshahrani |
| author_facet | Khalid Altirkawi Alwalid Alteraif Abobaker Alshathli Khalid Almoosa Turki Alshahrani |
| author_sort | Khalid Altirkawi |
| collection | DOAJ |
| description | Background:
Respiratory failure requiring mechanical ventilation (MV) is a significant challenge for preterm infants, particularly those born before 29 weeks of gestation. Prolonged MV is associated with adverse respiratory and neurodevelopmental outcomes. Extubation failure (EF) remains common, with ˃67% of preterm infants failing initial attempts. This study aimed to identify predictors of EF and develop a practical extubation readiness model.
Methods:
This case–control study included preterm infants born before 33 weeks of gestation. Infants were categorized into EF (n = 27) and extubation success (n = 81) groups, matched for gestational age (GA), birth weight (BW), sex, and admission month. Pre- and postextubation variables, including ventilator settings, blood gas measurements, and comorbidities were analyzed. Logistic regression and Kaplan–Meier analyses identified predictors and characterized EF timing.
Results:
Lower preextubation fraction of inspired oxygen (FiO2) (0.27 vs. 0.32, P < 0.05) and mean airway pressure (MAP) (8.05 vs. 8.44 cmH2O, P = 0.052) were associated with successful extubation. EF was associated with higher mortality (26% vs. 7%, P = 0.01) and severe broncho-pulmonary dysplasia (BPD) (22% vs. 4%, P < 0.002). A three-variable model (surfactant use, FiO2, and MAP) achieved an area under the receiver operating characteristic curve of 0.77. Most reintubations (59%) occurred within 24 h, with higher BW and GA associated with delayed reintubation.
Conclusion:
Lower FiO2 and MAP before extubation were predictive of successful extubation, whereas EF was associated with higher mortality and severe BPD. This three-variable model offers practical utility in assessing extubation readiness. Further research should standardize the extubation criteria and explore the integration of advanced technologies to support decision-making. |
| format | Article |
| id | doaj-art-f3b5a1a5e7514b92b7020a4e1bec1fc1 |
| institution | Kabale University |
| issn | 2773-1545 2773-1553 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Advances in Biomedical and Health Sciences |
| spelling | doaj-art-f3b5a1a5e7514b92b7020a4e1bec1fc12025-08-20T03:44:32ZengWolters Kluwer Medknow PublicationsAdvances in Biomedical and Health Sciences2773-15452773-15532025-07-014314114710.4103/abhs.abhs_7_25Predicting successful extubation in very preterm infants: A case–control study on key respiratory and clinical predictorsKhalid AltirkawiAlwalid AlteraifAbobaker AlshathliKhalid AlmoosaTurki AlshahraniBackground: Respiratory failure requiring mechanical ventilation (MV) is a significant challenge for preterm infants, particularly those born before 29 weeks of gestation. Prolonged MV is associated with adverse respiratory and neurodevelopmental outcomes. Extubation failure (EF) remains common, with ˃67% of preterm infants failing initial attempts. This study aimed to identify predictors of EF and develop a practical extubation readiness model. Methods: This case–control study included preterm infants born before 33 weeks of gestation. Infants were categorized into EF (n = 27) and extubation success (n = 81) groups, matched for gestational age (GA), birth weight (BW), sex, and admission month. Pre- and postextubation variables, including ventilator settings, blood gas measurements, and comorbidities were analyzed. Logistic regression and Kaplan–Meier analyses identified predictors and characterized EF timing. Results: Lower preextubation fraction of inspired oxygen (FiO2) (0.27 vs. 0.32, P < 0.05) and mean airway pressure (MAP) (8.05 vs. 8.44 cmH2O, P = 0.052) were associated with successful extubation. EF was associated with higher mortality (26% vs. 7%, P = 0.01) and severe broncho-pulmonary dysplasia (BPD) (22% vs. 4%, P < 0.002). A three-variable model (surfactant use, FiO2, and MAP) achieved an area under the receiver operating characteristic curve of 0.77. Most reintubations (59%) occurred within 24 h, with higher BW and GA associated with delayed reintubation. Conclusion: Lower FiO2 and MAP before extubation were predictive of successful extubation, whereas EF was associated with higher mortality and severe BPD. This three-variable model offers practical utility in assessing extubation readiness. Further research should standardize the extubation criteria and explore the integration of advanced technologies to support decision-making.https://journals.lww.com/10.4103/abhs.abhs_7_25extubation readinessmechanical ventilationneonatepredictors of extubation successpreterm |
| spellingShingle | Khalid Altirkawi Alwalid Alteraif Abobaker Alshathli Khalid Almoosa Turki Alshahrani Predicting successful extubation in very preterm infants: A case–control study on key respiratory and clinical predictors Advances in Biomedical and Health Sciences extubation readiness mechanical ventilation neonate predictors of extubation success preterm |
| title | Predicting successful extubation in very preterm infants: A case–control study on key respiratory and clinical predictors |
| title_full | Predicting successful extubation in very preterm infants: A case–control study on key respiratory and clinical predictors |
| title_fullStr | Predicting successful extubation in very preterm infants: A case–control study on key respiratory and clinical predictors |
| title_full_unstemmed | Predicting successful extubation in very preterm infants: A case–control study on key respiratory and clinical predictors |
| title_short | Predicting successful extubation in very preterm infants: A case–control study on key respiratory and clinical predictors |
| title_sort | predicting successful extubation in very preterm infants a case control study on key respiratory and clinical predictors |
| topic | extubation readiness mechanical ventilation neonate predictors of extubation success preterm |
| url | https://journals.lww.com/10.4103/abhs.abhs_7_25 |
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