Thesis (M.Sc.) - Cairo University - Faculty of Medicine- Department of Pediatrics

Background: Extubation failure (EF), defined as the need for re-intubation within 24{u2013}72 hrs. Factors predicting EF in adults are generally not useful in neonates. Objective: To determine the predictors, factors associated with EF and to facilitate the prediction of EF in mechanically ventilated neonates. Material and Methods: A randomized follow up clinical trial. It was conducted in the NICU of Al Kasr Al Ainy. All patients included were neonates. They stayed on the ventilator for more than 12 hrs. Patients with upper airway obstruction, accidental extubation, tracheostomy, or death before extubation were excluded. The pre-extubation clinical, laboratory and ventilatory parameters were collected for 150 cases over a six months period. Results: The study revealed that the usage of dexamethasone with normal chest x-ray during extubation had a high rate of successful extubation. In contrary; factors as pnemothorax, apnea, pneumonia, ventilator setting (high PIP, high PEEP, prolonged duration of mechanical ventilation), usage of dopamine and dobutamine, high amount of secretions, work of breathing (tachypnea, retractions, deep breathing) and laboratory findings (low PH, bicarbonate) had a high rate of extubation failure. Conclusion: Neonatal EF may be multifactorial. The measurement of respiratory efforts and ventilatory parameters were necessary in deciding re-intubation. The major factors associated with extubation failure were pneumothorax and apnea

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