Feasibility of weaning and direct extubation from open lung high-frequency ventilation in preterm infants.

Objective: High-frequency ventilation (HFV) is increasingly used in preterm infants, but data on weaning and extubation are limited. We aimed to establish if weaning the continuous distending pressure (CDP) below 8 cm H2O and the FIO2 below 0.30 is feasible in preterm infants on open lung HFV and if these settings result in successful extubation. Design: Retrospective cohort study. Setting: Neonatal intensive care unit in a university hospital. Patients: Preterm infants ventilated and directly extubated from HFV between January 2003 and August 2005. Measurements and Main Results: Data on patient characteristics, ventilator settings, gas exchange, respiratory support after extubation and the number of patients failing extubation (i.e., reintubation within 48 hr) were retrospectively collected. Two hundred fourteen infants, accounting for 242 ventilation periods, were included in the study. The CDP, but not the FIO2, decreased significantly in the 24-hr period before extubation, resulting in a mean CDP of 6.8 +/- 1.6 cm H2O and a mean FIO2 of 0.25 at the time of extubation. At these settings, 193 (90%) infants were successfully extubated. Multivariate logistic regression analysis showed that birth weight was the only independent variable positively associated with successful extubation. Conclusion: This study shows that weaning the CDP below 8 cm H2O with an FIO2 below 0.30 is feasible during open lung HFV and extubation at these settings can be successful in preterm infants. In our series, a 90% success rate was observed. The value of this approach should be prospectively compared with conventional weaning and extubation strategies. (Pediatr Grit Care Med 2009; 10:71-75)