Determination of risk factors related to extubation failure in patients undergoingmechanical ventilation in the neonatal intensive care unit

Determination of Risk Factors Related to Extubation Failure in Patients Undergoing Mechanical Ventilation in the Neonatal Intensive Care Unit Aim: Intubation and mechanical ventilation are life-saving in cases where advanced respiratory support is needed in the neonatal period, but extubation should be performed as soon as possible to avoid the morbidity caused by it. However, it should be tried to avoid problems that may arise as a result of unsuccessful extubation. Our aim in this study is to determine the risk factors for extubation failure in patients who underwent invasive mechanical ventilation for any reason in the neonatal intensive care unit, to take precautions for them, to determine the appropriate extubation time, and to reduce extubation failure and re-intubations. Material and Method: The clinical and demographic characteristics and blood gase evaluations before and after extubation of 100 patients who were hospitalized in İnönü University Turgut Özal Medical Center Neonatal Intensive Care Unit for any reason and who needed mechanical ventilation were evaluated. Extubation failure was defined as the need for re-entubation again in less than 72 hours after extubation. The patients with and without extubation failure were compared to each other. Results: The mean birth age of our patients was 32,7±5,0 weeks and the extubation failure rate was 36%. While the most common indication was RDS (35%), extubation failure was found most frequently in patients with RDS (58,8%). Low gestational age, low 5th minute Apgar score, high SNAPPE-II score, and need for repeated surfactant treatments were also significantly associated with extubation failure. In addition, pH values before extubation and one hour later after extubation were low in patients with extubation failure. The rates of ventilator-associated pneumonia and bronchopulmonary dysplasia were higher in patients with extubation failure. The mortality rate was higher in patients with extubation failure but it was not statistically significant. Conclusion: Potential factors associated with extubation failure have been identified. Considering these risk factors, the production of a common, clear and effective extubation protocol and training of physicians in this regard will increase the success. Keywords: Bronchopulmonary dysplasia, extubation failure, mechanical ventilation, ventilator-associated pneumonia