The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

MORTALITY RISK ASSOCIATED WITH RE-INTUBATION IN PRETERM INFANTS TREATED WITH DIFFERENT SURFACTANTS

Carlos Guardia1, Fernando R. Moya2, Phillip Simmons1



Background: Infants who are extubated after initial surfactant administration and require re-intubation are presumptively at higher risk for poor outcomes. We examined extubation rates and the subsequent need for re-intubation and its impact on survival in infants enrolled in two recent surfactant comparator trials (SELECT: Moya et al. Pediatrics. 2005;115:1018 and STAR: Sinha et al. Pediatrics. 2005;115:1030).

Methods:
The rates of initial extubation, reintubation, mortality, and the combined outcome of survival and need for re-intubation were calculated. Comparisons between treatments were done in infants extubated at least once through 36 weeks post menstrual age using logistic regression, adjusted for birth weight stratum and center for extubation, re-intubation, and mortality rates; or Chi-square otherwise.

Results:
Overall rates of extubation were similar across treatments in both trials (range 81-84% for all randomized neonates; p=ns). Regardless of the surfactant received, infants who were extubated and never required re-intubation had low mortality (0-1%) while infants who required re-intubation had a significantly higher mortality rate (OR 55; CI 17.4-176: see Table 1). Re-intubation rates following initial extubation was significantly lower (p<0.05) for infants treated with lucinactant compared with beractant or poractant alfa. Correspondingly, the combined outcome of survival and without re-intubation was significantly higher (p<0.05) for infants treated with lucinactant compared with beractant or poractant alfa (Table 1).

Conclusion:
Need for subsequent re-intubation after successful extubation is associated with a significantly higher risk of mortality in preterm infants. Although initial extubation rates were similar among comparator surfactants, in infants treated with lucinactant the rate of subsequent re-intubation as well as the combined outcome of survival and without re-intubation was improved compared with infants treated with beractant and poractant alfa.
Supported by Discovery Laboratories.