FAILED EXTUBATION IN THE NEONATAL INTENSIVE-CARE UNIT

One of the roles of the pediatric otolaryngologist in the neonatal int ensive care unit (NICU) is the assessment and management of the neonat e who fails a trial of extubation. This paper reviews the recent 5-yea r institutional experience at The Hospital for Sick Children, Toronto, with neonates who failed extubation and who subsequently underwent di agnostic endoscopy. One hundred twenty-eight neonates from the NICU un derwent diagnostic endoscopy. Of these, 58 neonates underwent diagnost ic endoscopy for failure to extubate. Nine neonates were extubated aft er diagnostic endoscopy and retrial (16% of the series). Eleven neonat es were extubated after additional endoscopic procedures (19% of the s eries). Twenty-four neonates underwent anterior cricoid split, of whom 20 or 83% (34% of the series) were eventually successfully extubated with no further airway intervention required during the study period ( minimum 6 months' follow-up). Eleven neonates underwent tracheotomy (1 9% of the series). Four neonates underwent another external procedure to allow extubation (7% of the series). Three neonates died while stil l intubated (5% of the series). Our management of the neonate who fail s a trial of extubation is discussed.