RANDOMIZED, CONTROLLED, BLINDED TRIAL OF DOXAPRAM FOR EXTUBATION OF THE VERY-LOW-BIRTH-WEIGHT INFANT

The objective of the study was to determine whether administering doxa pram by infusion to the very low birthweight infant, prior to extubati on during the first 3 weeks of life, would increase the incidence of s uccessful extubation. The study patients, 56 infants of less than 1251 g birthweight and less than 30 weeks' gestation, were entered in the first 3 weeks of life when lung disease had started to improve. A rand omized blinded trial was performed, with infants receiving 3.5 mg kg(- 1) doxapram bolus, followed by an infusion at 1 mg kg(-1) h(-1), or pl acebo. Weaning from positive pressure ventilation was standardized and extubation occurred after a 12 h trial of an intermittent mandatory v entilation (IMV) rate of 6 breaths min(-1), if PCO2 < 55 mmHg, pH > 7. 26, and FiO(2) < 0.45. Study drug was continued for 48 h postextubatio n, and the infants were placed on nasopharyngeal continuous positive a irway pressure (CPAP) for 72h postextubation. Extubation failure withi n the first 72 h after extubation was objectively defined in terms of acidosis (pH < 7.26), hypercarbia (PCO2 > 55 mmHg), excessive oxygen r equirement (FiO(2) > 0.8) or frequent apnoea (more than three in 12 h, or more than two requiring face mask IMV in 24 h). No difference was noted in the frequency of successful extubation between the groups. Fi fteen infants in each group were successfully extubated before the 10t h day of the study. In conclusion, when given in accordance with this protocol doxapram does not increase the likelihood of successful extub ation in the very low birthweight infant. Increasing successful extuba tions in this group of infants will require other strategies.