Extubation from high-frequency oscillatory ventilation in extremely low birth weight infants: a prospective observational study

Objective: To evaluate if weaning from high-frequency oscillatory ventilation (HFOV) directly to a non-invasive mode of respiratory support is feasible and results in successful extubation in extremely low birth weight (ELBW) infants.

Design: Prospective observational study.

Setting: Tertiary neonatal intensive care unit.

Patients: One hundred and eight ELBW infants of 26.2±1.4 weeks of gestational age (GA) directly extubated from HFOV.

Interventions: All infants were managed with elective HFOV and received surfactant after a recruitment HFOV manoeuvre. Extubation was attempted at mean airways pressure (MAP) ≤6 cm H₂O with FiO₂ ≤0.25. After extubation, all infants were supported by nasal continuous positive airway pressure (6-8 cm H₂O).

Main outcome measures: Extubation failure (clinical deterioration requiring reintubation) was defined as shorter than 7 days.

Results: Ninety patients (83%) were successfully extubated and 18 (17%) required reintubation. No significant differences were found between the two groups in terms of birth weight, day of life and weight at the time of extubation. Multivariable analysis showed that GA (OR 1.71; 95% CI 1.04, 2.08) and higher MAP prior to surfactant (OR 1.51; 95% CI 1.06, 2.15) were associated with successful extubation.

Conclusions: In ELBW infants, direct extubation from HFOV at MAP ≤6 cm H₂O with FiO₂ ≤0.25 is feasible. Our extubation success rate (83%) is higher than conventional mechanical ventilation in this very vulnerable class of infants.