Effects of an Extubation Readiness Test Protocol at a Tertiary Care Fully Outborn Neonatal Intensive Care Unit

Background and Objectives: Extubation readiness testing (ERT) in the Neonatal Intensive Care Unit (NICU) is highly variable and lacking standardized criteria. To address this gap, an evidence-based, inter-professionally developed ERT protocol was implemented to assess effectiveness on extubation failure within 72 hours, and on duration of intubation (DOI).

Methods: A longitudinal retrospective chart review in a level III, fully outborn NICU, of intubated infants admitted one-year prior (Group 1), and one year after implementation (Group 2). Patients were extubated if they passed a two-stage ERT protocol (3 minutes continuous positive airway pressure followed by 7 minutes pressure support). Descriptive, comparative statistics, univariate and multiple logistic regression were completed on all patients, and a ≤ 32 6/7 weeks subgroup (intubated at day of life one). A p

Results: N=589 (n=294 Group 1, n=295 Group 2) were included (pre-term subgroup: n=42 Group 1, n=38 Group 2). For all patients, extubation failure decreased significantly from 9.9% to 4.1% (p=0.006); Group 1 patients were over 2.5 times more likely to experience extubation failure compared to Group 2. Extubation failure in the pre-term subgroup decreased from 21.7% to 2.6% (p=0.01); Group 1 patients were 11 to 14 times more likely to experience extubation failure. Median DOI was similar in both groups for all patients and in the pre-term subgroup.

Conclusions: A unique two-stage ERT protocol was effective at reducing extubation failure rate, without increasing DOI, largely in pre-term infants. The evidence-based, interprofessionally developed ERT protocol, and its integration into the NICU culture largely contributed to its success.