Abstract
Background
The optimal approach for reporting reintubation rates in extremely preterm infants is unknown. This study aims to longitudinally describe patterns of reintubation in this population over a broad range of observation windows following extubation.
Methods
Timing and reasons for reintubation following a first planned extubation were collected from infants with birth weight ≤1,250 g. An algorithm was generated to discriminate between reintubations attributable to respiratory and non-respiratory causes. Frequency and cumulative distribution curves were constructed for each category using 24 h intervals. The ability of observation windows to capture respiratory-related reintubations while limiting non-respiratory reasons was assessed using a receiver operating characteristic curve.
Results
Out of 194 infants, 91 (47%) were reintubated during hospitalization; 68% for respiratory and 32% for non-respiratory reasons. Respiratory-related reintubation rates steadily increased from 0 to 14 days post-extubation before reaching a plateau. In contrast, non-respiratory reintubations were negligible in the first post-extubation week, but became predominant after 14 days. An observation window of 7 days captured 77% of respiratory-related reintubations while only including 14% of non-respiratory cases.
Conclusion
Reintubation patterns are highly variable and affected by the reasons for reintubation and observation window used. Ideally, reintubation rates should be reported using a cumulative distribution curve over time.
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The project has received funding via an operational grant from the Canadian Institutes of Health Research. The funding body did not have a role in the design and collection, analysis, or interpretation of the data.
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Shalish, W., Kanbar, L., Keszler, M. et al. Patterns of reintubation in extremely preterm infants: a longitudinal cohort study. Pediatr Res 83, 969–975 (2018). https://doi.org/10.1038/pr.2017.330
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DOI: https://doi.org/10.1038/pr.2017.330
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