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Respiratory Setback Associated with Extubation Failure in Extremely Preterm Infants
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  • Dhruv Gupta,
  • Rachel Greenberg,
  • Girija Natarajan,
  • Sanket Jani,
  • Amit Sharma,
  • Michael Cotten,
  • Ronald Thomas,
  • Sanjay Chawla
Dhruv Gupta
Children's Hospital of Michigan
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Rachel Greenberg
Duke University
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Girija Natarajan
Wayne State University
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Sanket Jani
Children's Hospital of Michigan
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Amit Sharma
Children's Hospital of Michigan
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Michael Cotten
Duke University
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Ronald Thomas
Children's Hospital of Michigan
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Sanjay Chawla
Wayne State University
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Abstract

Background and Objectives: Extubation failure in preterm infants is associated with increased risk of mortality and morbidities. There is limited evidence to suggest if the increased morbidities are due to inherent differences among infants who fail or succeed; or whether these are due to a true respiratory setback among those who fail extubation. The aim of this study was to evaluate the respiratory status of infants who fail extubation and to assess the time taken for these infants to achieve pre-extubation respiratory status. Methods: This was a retrospective study of infants with birth weight ≤1,250 g who were born between January 2009 and December 2016. Infants were eligible if they failed first elective extubation. Extubation failure was defined as need for re-intubation within 5 days of extubation. Ventilator settings, blood gas parameters, respiratory severity score and ventilation index were used to assess respiratory status of infants. Results: Of 384 infants, 76% were successful and 24% failed extubation. Among those who failed extubation 91%, 77% and 56% infants remained intubated at 24 hours, 72 hours and 7 days, respectively. Respiratory status was worse at 24 hours and 72 hours after re-intubation when compared to pre-extubation levels. The median times for respiratory severity score and ventilation index to reach pre-extubation levels were 4 days and 7 days respectively. Conclusion: Among preterm infants, failed elective extubation is associated with a significant setback in the respiratory status. Infants who fail an extubation attempt may not achieve pre-extubation respiratory status for many days after reintubation.

Peer review status:Published

13 Nov 2020Submitted to Pediatric Pulmonology
17 Nov 2020Submission Checks Completed
17 Nov 2020Assigned to Editor
19 Nov 2020Reviewer(s) Assigned
27 Nov 2020Review(s) Completed, Editorial Evaluation Pending
27 Nov 2020Editorial Decision: Revise Major
28 Dec 20201st Revision Received
29 Dec 2020Assigned to Editor
29 Dec 2020Submission Checks Completed
29 Dec 2020Reviewer(s) Assigned
03 Jan 2021Review(s) Completed, Editorial Evaluation Pending
03 Jan 2021Editorial Decision: Revise Minor
02 Feb 20212nd Revision Received
02 Feb 2021Submission Checks Completed
02 Feb 2021Assigned to Editor
02 Feb 2021Reviewer(s) Assigned
21 Feb 2021Review(s) Completed, Editorial Evaluation Pending
22 Feb 2021Editorial Decision: Revise Minor
07 Mar 20213rd Revision Received
08 Mar 2021Submission Checks Completed
08 Mar 2021Assigned to Editor
08 Mar 2021Reviewer(s) Assigned
08 Mar 2021Review(s) Completed, Editorial Evaluation Pending
11 Mar 2021Editorial Decision: Accept
05 Apr 2021Published in Pediatric Pulmonology. 10.1002/ppul.25387