BACKGROUND: The current generation of neonatal ventilators enables periodic storage of set, measured, and calculated ventilatory parameters. DESIGN: Retrospective observational study. OBJECTIVES: To evaluate and identify the ventilatory, demographic, and clinical pre-extubation variables that are significant for estimating extubation readiness. METHODS: Eligible subjects included premature infants <33 weeks of gestation weaned from mechanical ventilation (MV) lasting >24 h. A total of 16 relevant ventilator variables, each calculated from 288 data points over 24 h, together with eight demographic and three clinical pre-extubation variables, were used to create the generalized linear model (GLM) for a binary outcome and the Cox proportional hazards model for time-to-event analysis. The achievement of a 120-h period without reintubation was defined as a successful extubation attempt (EA) within the binary outcome. RESULTS: We evaluated 149 EAs in 81 infants with a median (interquartile range) gestational age of 25+2 (24+3-26+1) weeks. Of this, 90 EAs (60%) were successful while 59 (40%) failed. GLM identified dynamic compliance per kilogram, percentage of spontaneous minute ventilation, and postmenstrual age as significant independent positive variables. Conversely, dynamic compliance variability emerged as a significant independent negative variable for extubation success. This model enabled the creation of a probability estimator for extubation success with a good proportion of sensitivity and specificity (80% and 73% for a cut-off of 60%, respectively). CONCLUSIONS: Ventilator variables reflecting lung mechanical properties and the ability to spontaneously breathe during MV contribute to better prediction of extubation readiness in extremely premature infants with chronic lung disease.

Department of Biomedical Technology Faculty of Biomedical Engineering Czech Technical University Prague Prague Czech Republic

Department of Gynaecology Obstetrics and Neonatology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Institute of Medical Biochemistry and Laboratory Diagnostics 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

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Al‐Mandari H, Shalish W, Dempsey E, Keszler M, Davis PG, Sant'Anna G. International survey on periextubation practices in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. 2015;100:F428‐F431. 10.1136/archdischild-2015-308549 PubMed DOI

Shalish W, Kanbar L, Kovacs L, et al. The impact of time interval between extubation and reintubation on death or bronchopulmonary dysplasia in extremely preterm infants. J Pediatr. 2019;205:70‐76.e2. 10.1016/j.jpeds.2018.09.062 PubMed DOI

Jensen EA, DeMauro SB, Kornhauser M, Aghai ZH, Greenspan JS, Dysart KC. Effects of multiple ventilation courses and duration of mechanical ventilation on respiratory outcomes in extremely low‐birth‐weight infants. JAMA Pediatrics. 2015;169:1011. 10.1001/jamapediatrics.2015.2401 PubMed DOI PMC

Hatch LD. Endotracheal intubation in neonates: a prospective study of adverse safety events in 162 infants. J Pediatr. 2019;168:11. PubMed PMC

Shalish W, Latremouille S, Papenburg J, Sant'Anna GM. Predictors of extubation readiness in preterm infants: a systematic review and meta‐analysis. Arch Dis Child Fetal Neonatal Ed. 2019;104:F89‐F97. 10.1136/archdischild-2017-313878 PubMed DOI

Shalish W, Kanbar L, Kovacs L, et al. Assessment of extubation readiness using spontaneous breathing trials in extremely preterm neonates. JAMA Pediatrics. 2020;174:178. 10.1001/jamapediatrics.2019.4868 PubMed DOI PMC

Kavvadia V, Greenough A, Dimitriou G. Prediction of extubation failure in preterm neonates. Eur J Pediatr. 2000;159:227‐231. 10.1007/s004310050059 PubMed DOI

Kamlin COF. Predicting successful extubation of very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2005;91:F180‐F183. 10.1136/adc.2005.081083 PubMed DOI PMC

Chawla S, Natarajan G, Gelmini M, Kazzi SNJ. Role of spontaneous breathing trial in predicting successful extubation in premature infants. Pediatr Pulmonol. 2013;48:443‐448. 10.1002/ppul.22623 PubMed DOI

Kaczmarek J, Kamlin COF, Morley CJ, Davis PG, Sant'Anna GM. Variability of respiratory parameters and extubation readiness in ventilated neonates. Arch Dis Child Fetal Neonatal Ed. 2013;98:F70‐F73. 10.1136/fetalneonatal-2011-301340 PubMed DOI

Dassios T, Williams E, Ambulkar H, Shetty S, Hickey A, Greenough A. Tidal volumes and outcome of extubation in mechanically ventilated premature infants. Am J Perinatol. 2020;37:204‐209. 10.1055/s-0039-1696714 PubMed DOI

Dimitriou G, Fouzas S, Vervenioti A, Tzifas S, Mantagos S. Prediction of extubation outcome in preterm infants by composite extubation indices. Pediatr Crit Care Med. 2011;12:e242‐e249. 10.1097/PCC.0b013e3181fe3431 PubMed DOI

Gupta D, Greenberg RG, Sharma A, et al. A predictive model for extubation readiness in extremely preterm infants. J Perinatol. 2019;39:1663‐1669. 10.1038/s41372-019-0475-x PubMed DOI

Mammel MC, Donn SM. Real‐time pulmonary graphics. Semin Fetal Neonatal Med. 2015;20:181‐191. 10.1016/j.siny.2015.01.004 PubMed DOI

Gibbs K, Jensen EA, Alexiou S, Munson D, Zhang H. Ventilation strategies in severe bronchopulmonary dysplasia. NeoReviews. 2020;21:e226‐e237. 10.1542/neo.21-4-e226 PubMed DOI

Ferguson KN, Roberts CT, Manley BJ, Davis PG. Interventions to improve rates of successful extubation in preterm infants: a systematic review and meta‐analysis. JAMA Pediatrics. 2017;171:165. 10.1001/jamapediatrics.2016.3015 PubMed DOI