Noninvasive Ventilation or CPAP for Post-Extubation Support in Small Infants

Abstract

Background: Infants with a high risk of extubation failure are often treated with noninvasive ventilation (NIV) or CPAP, but data on the role of these support modalities following extubation are sparse. This report describes our experience using NIV or CPAP to support infants following extubation in our pediatric ICUs.

Methods: We performed a retrospective study of children < 10 kg receiving post-extubation NIV or CPAP in our pediatric ICUs. Data on demographics, medical history, type of support, vital signs, pulse oximetry, near-infrared spectroscopy (NIRS), gas exchange, support settings, and reintubation were extracted from the electronic medical record. Support was classified as prophylactic if planned before extubation and rescue if initiated within 24 hours of extubation. We compared successfully extubated and reintubated subjects using Chi-square for categorical variables and Mann-Whitney test for continuous variables.

Results: We studied 51 subjects, median age 44 (IQR 0.5-242) days and weight 3.7 (3.0-4.9) kg. There were no demographic differences between groups, except those reintubated were more likely to have had cardiac surgery prior to admission (0% vs 14% P = .04). NIV was used in 31 (61%) and CPAP in 20 (39%) subjects. Prophylactic support was initiated in 25 subjects (49%) while rescue support was needed in 26 subjects (51%). Twenty-two subjects (43%) required reintubation. Reintubation rate was higher for rescue support (58% vs. 28%, P = .03). Subjects with a pH < 7.35 (4.3% vs 42%, P = .003) and lower somatic NIRS (39 [24-56] vs. 62 [46-72], P = .02) were more likely to be reintubated. The IPAP, EPAP, and FIO₂ were higher in subjects who required reintubation.

Conclusions: NIV or CPAP use was associated with a reintubation rate of 43% in a heterogeneous sample of high-risk infants. Acidosis, cardiac surgery, higher FIO₂, lower somatic NIRS, higher support settings, and application of rescue support were associated with the need for reintubation.