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PO-0726 International Survey On Peri-extubation Practices In Extremely Premature Infants
  1. H Al Mandhari1,
  2. W Shalish2,
  3. E Dempsey3,
  4. M Keszler4,
  5. P Davis5
  1. 1Pediatrics, Montreal Children’s Hopsital McGill University Health Centre, Montreal, Canada
  2. 2Neonatology, Montreal Children’s Hopsital McGill University Health Centre, Montreal, Canada
  3. 3Pediatrics, Cork University, Cork, Ireland
  4. 4Neonatology, Brown University, Rhode Island, USA
  5. 5Neonatology, University of Melbourne, Melbourne, Australia

Abstract

Background Weaning of mechanical ventilation (MV), assessment of extubation readiness and provision of post-extubation support are critical steps in the care of extremely preterm infants (< 28 weeks). The use of evidence-based practices during the peri-extubation phase is paramount for ensuring successful outcome.

Objective Determine the peri-extubation practices used in extremely preterm infants internationally.

Methods From Oct 2013 to Feb 2014 a structured questionnaire with 15 questions related to peri-extubation practices was circulated to the clinical directors of 162 neonatal intensive care units across Canada, USA, Ireland, Australia and New Zealand.

Results 112 directors responded to the questionnaire (69%). The majority of units do not have written protocols for any aspect of MV (64%). The decision to extubate is generally made by the attending neonatologist (99%) or neonatal fellows (71%), based on ventilator settings, blood gases and haemodynamic stability; 16% of units extubate infants based on Spontaneous Breathing Trial (SBT). The SBT’s varied on definitions of failure and durations; from <5 min (59%) to >10 min (35%). The majority of infants are extubated ≤3 days of life (76%) to nasal CPAP (84%). The failure rate was estimated to be 10–30%, but there was lack of consensus on the definition of failure (re-intubation within 24, 48 or 72 h after extubation). The decision to reintubate was almost always based on clinical judgement of physicians (88%), rather than well defined re-intubation criteria.

Conclusions Peri-extubation practices in extremely preterm infants are not always evidence based and frequently physician-dependent. High quality trials are required to inform guidelines and standardise practices for this important aspect of neonatal intensive care.

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