Predictive factors for successful extubation in preterm infants: Relationship with weight, PaCO ₂ and heart rate

Objective To identify variables associated with extubation success in preterm infants undergoing first elective extubation and to determine cutoff values to support clinical decision-making. Methods This retrospective cohort study included preterm infants (gestational age ≤36 weeks and 6 days) admitted to a neonatal intensive care unit who underwent first elective extubation after orotracheal intubation. Extubation failure was defined as reintubation within 48 h. Bivariate and multivariate analyses were performed. Discriminant analysis defined cutoff values, and bootstrapping (500 replicates) supported comparisons. Results Among 218 eligible infants, 73.9% achieved extubation success. In multivariate analysis, weight at extubation (OR 1.02; 95% CI 1.01–1.04), PaCO 2 (OR 0.93; 95% CI 0.89–0.98), and heart rate (OR 0.97; 95% CI 0.94–0.99) were independently associated with success. Cutoff values were 34.7 mmHg for PaCO 2 and 156 bpm for heart rate, both with modest sensitivity and specificity. Conclusions Weight at extubation, PaCO 2 , and heart rate were independently associated with extubation success. Although their discriminatory performance was modest, these variables may provide clinically relevant information when interpreted within the context of early extubation. Their integration into a multidimensional assessment may support more individualized decision-making.