The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

EVALUATION OF OPTIMAL EXTUBATION SETTINGS FOR PATIENTS WITH SEVERE BRONCHOPULMONARY DYSPLASIA.

Erin Wishloff, Brandon Kuehne, Edward Shepherd; Neonatal Respiratory Therapy, Nationwide Children's Hospital, Columbus, OH

Background: Extubating patients with bronchopulmonary dysplasia (BPD) from mechanical ventilation is often difficult. There is little data in the literature to predict successful extubation in this group. The Comprehensive Center for Bronchopulmonary Dysplasia (CCBPD) is a chronic care facility focused on infants with BPD and has significant experience extubating such patients. Objective: Our objective is to review all planned attempts to extubate patients with severe BPD and to determine if any pre-extubation clinical variables or ventilator settings are associated with greater rates of success. Methods: A chart review of planned extubation attempts in our CCBPD unit over a time period of over 3 years was performed. We recorded standard clinical and demographic data, including corrected gestational age (CGA), patient weight at extubation, history of necrotizing enterocolitis (NEC), interventricular hemorrhage (IVH), and ventilator settings prior to extubation. We then compared clinical data between those successfully extubated and those reintubated using single factor analysis of variation (ANOVA). We defined successful extubation attempts as avoiding the need to intubate for at least 72 hours. Informal unit guidelines suggested achieving a level of 40% FIO2 or below before a planned extubation was attempted. Results: Data was analyzed for 94 planned extubations involving a total of 62 patients. Sixty-one attempts were successful (65%). There were no statistically significant differences between successfully and unsuccessfully extubated groups in CGA (p=0.92), FIO2 (p=0.91), weight at extubation (p=0.29), Inspiratory Time (p=0.61), Respiratory Rate (p=0.56), or Positive End Expiratory Pressure (p=0.28). There was a statistically significant association between Peak Inspiratory Pressure (p=0.02) and Mean Airway Pressure (p=0.058) for successful extubations. Conclusions: This study suggests that the ventilator parameters of Peak Inspiratory Pressure and Mean Airway Pressure are statistically associated with successful extubations in patients with severe BPD. Moreover, patient demographics such as CGA, history of NEC and/or IVH did not seem to predict success. Notably, this study does demonstrate that patients with severe BPD can be extubated successfully from very high ventilator settings.
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Ventilator Settings at Extubation