Prediction of extubation outcome in preterm infants by composite extubation indices

Objective: To determine whether composite extubation indices can predict extubation outcome in preterm infants. Design: Prospective observational study. Setting: Level III neonatal intensive care unit. Patients: Fifty-six preterm infants cared for in the neonatal intensive care unit of a tertiary teaching hospital during 2007 and 2008. Interventions: None. Measurements and Main Results: The study consisted of two parts. In the first part, different extubation indices were evaluated in a group of 28 neonates (derivation group). These indices included the diaphragmatic pressure-time index, the respiratory muscle pressure-time index, the maximal transdiaphragmatic pressure, the maximal inspiratory pressure, the airway pressure generated 100 milliseconds after an occlusion/maximal transdiaphragmatic pressure ratio, the airway pressure generated 100 milliseconds after an occlusion/maximal inspiratory pressure ratio, the tidal volume, and the respiratory rate to tidal volume ratio. After exploratory analysis, the best performing indices and the optimal threshold values to predict extubation outcome were selected. In the second part of the study, these indices were validated at the predetermined threshold values in an additional group of 28 preterm neonates (validation group). Four infants (14.3%) in the derivation group and four in the validation group (14.3%) failed extubation. Receiver operator characteristic curve analysis revealed that a diaphragmatic pressure-time index of <= 0.12, a respiratory muscle pressure-time index <= 0.10, a airway pressure generated 100 milliseconds after an occlusion/maximal transdiaphragmatic pressure of <= 0.14, and a airway pressure generated 100 milliseconds after an occlusion/maximal inspiratory pressure of <= 0.09 were the most accurate predictors of extubation outcome in the derivation group. In the validation group, a diaphragmatic pressure-time index of <= 0.12 and a respiratory muscle pressure-time index of <= 0.10 both had zero false-positive results, predicting with accuracy successful extubation. Conclusion: Composite extubation indices such as the diaphragmatic pressure-time index and the noninvasive respiratory muscle pressure-time index can accurately predict extubation outcome in preterm neonates. (Pediatr Crit Care Med 2011; 12:e242-e249)