Extubation and Reintubation Rates in the NICU: An Observational Study

Introduction: Infants with Respiratory Distress Syndrome (RDS) require mechanical ventilation due to physiologic abnormalities that cause reduction in lung volumes, lung compliance, lung perfusion and alveolar ventilation despite increased work of breathing. Successful weaning and extubation from mechanical ventilation is dependent on the reversal of the clinical manifestations of RDS and the ability to adequately support spontaneous ventilation. The purpose of this study was to assess the causation and timing of extubation failure in neonates with RDS. We hypothesized that both the extubation and reintubation rates would be higher on the day shift (7am-7pm) versus night shift (7pm-7am).

Methods: Data were collected from November 1, 2001 to March 31,2002, on all intubated patients in the NICU weighing <1500g. Upon extubation, staff members recorded the patient?s gestational age, weight, date and time. For cases requiring reintubation, date, time, and reason for reintubations were recorded. Reasons for reintubation were classified as airway problems, uncontrolled secretions, respiratory acidosis, apnea and/or bradycardia, or respiratory distress characterized by grunting, flaring, and/or retractions. Rates were compared with Chi-Squared tests.

Results: There were 120 extubations among 57 patients (average 2.1 extubations/patient). Apneas, bradycardias, and respiratory distress accounted for 90% of the reintubations. Airway problems (6%) and respiratory acidosis (4%) were less common reasons. Data below are expressed as events per 100 ventilator days (and % of total).

Conclusion: Although the extubation rate was higher on the day shift, the reintubation rate was the same for both shifts. More than half (55%) of the reintubations were due to accidental extubation.