Tracheal extubation of the neonate at 2 to 3 cm H2O continuous positive airway pressure.

To investigate the efficacy of extubation at higher levels of continuous positive airway pressure (CPAP), 49 newborns (0.95 to 4.0 kg) were extubated at 2 to 3 cm H2O following 1 to 47 days of CPAP therapy. Pre- and postextubation measurements of Po2, PCO2, pH, FiO2, and CPAP were made in all infants. No significant differences (P less than.05) were found between pre- and post-extubation arterial blood gas values for all patients. Comparison of pre- and post-extubation blood gas data with respect to birthweight (less than 2.0 kg vs greater than 2.0 kg) and intubation time (less than 8 days vs. greater than 8 days) also indicated no statistical differences. Mean alveolar-arterial oxygen differences and FiO2 for 41 infants showed progressive decreases following extubation. Six of the 49 infants required reintubation within 72 hours following extubation. The results of this study indicate that newborns with respiratory disease requiring CPAP may be extubated at 2 to 3 cm H2O with no significant changes in arterial blood gas values, thus preventing prolonged intubation associated with weaning to 0 cm H2O CPAP.