(0262) Variations in Neonatal Extubation Protocols Across Institutions

Introduction: Despite the poor outcomes associated with neonatal extubation failure, there is no published, unified extubation protocol. This study aims to assess the agreement neonatologists have on various aspects of extubation.

Methods: A 22-question survey was sent to 211 neonatologists.

Results: Of the 16 criteria presented to the 70 respondents for consideration before neonatal extubation, respondents came to a near-unanimous consensus (defined as >80% agreement) on six (fraction of inspired oxygen, partial pressure of carbon dioxide, diaphragmatic pressure time, gender, and respiratory inductance plethysmography). The respondents had an agreement between 50–80% on six of the criteria (end tidal, respiratory rate, acid-base status, PaO2:FiO2 ratio, neurologic status, and previously failed extubation). The respondents had an agreement of < 50% on mean arterial pressure, intubation duration, gestational age, and birth weight. In addition, respondents had varied definitions of extubation failure duration (24 hours: 14.3%; 48 hours: 31.4%; 72 hours: 31.4%). 51.4% estimated that the national neonatal extubation failure rate is greater than what they consider to be acceptable, though 74.2% estimated that their own failure rate is less than or equal to what they consider to be acceptable.

Conclusions: Neonatologists across different institutions are generally not in agreement regarding criteria considered prior to extubation and do not have a consistent definition for extubation failure. Furthermore, though most believe that the national extubation failure rate is greater than what is acceptable, the majority also believe that their institution performs extubations competently. This ultimately points to a need to standardize neonatal extubation protocols nationwide.