Tracheal Extubation of the Neonate at 2 to 3 cm H2O Continuous Positive Airway Pressure

Abstract

To investigate the efficacy of extubation at higher levels of continuous positive airway pressure (CPAP), 49 newborns (0.95-4.0 kg) were extubated at 2-3 cm H2O following 1-47 days of CPAP therapy. Pre- and post-extubation measurements of PO2 [partial O2 tension], PCO2 [partial CO2 tension], pH, FiO2 [inspired O2 concentration] and CPAP were made in all infants. No significant differences (P < .05) were found between pre- and post-extubation arterial blood gas values for all patients. Comparison of pre- and post-extubation blood gas data with respect to birthweight (< 2.0 kg vs. > 2.0 kg) and intubation time (< 8 days vs. > 8 days) also indicated no statistical differences. Mean alveolar-arterial O2 differences and FiO2 for 41 infants showed progressive decreases following extubation. Six of the 49 infants required retubation within 72 h following extubation. Newborns with respiratory disease requiring CPAP may be extubated at 2-3 cm H2O with no significant changes in arterial blood gas values, thus preventing prolonged intubation associated with weaning to 0 cm H2O CPAP.