Ellen de Kort

28 Chapter 2 Table 1. Characteristics of included studies - continued Author Kind of study Inclusion criteria INSURE Exclusion criteria INSURE Verder et al. 1994 19 RCT GA 25-35 weeks, clinical and radiologic signs of RDS, PNA 2-72 hours, nCPAP with PEEP ≥6 cm H 2 O, a/A ratio ≤0.22 AS <3 at 5 min, PPROM >4 days, severe malformations, pneumonia, pneumothorax Verder et al.1999 21 RCT GA <30 weeks, PNA 2-72 hours, nCPAP with PEEP ≥6 cm H 2 O for RDS, a/A ratio 0.35-0.22 decreasing over a period of >30 min AS ≤2 at 5 min, PPROM >3 weeks, lethal malformations, pneumonia, incompletely treated pneumothorax Welzing et al.2010 17 Prospective cohort study GA 29-32 weeks, PNA <8 hours, moderate to severe respiratory distress (FiO 2 ≥0.30 on nCPAP for SpO 2 ≥88% or Silverman score ≥6) Any kind of disease not allowing early extubation Welzing et al. 2009 16 Prospective cohort study GA 29-32 weeks, PNA <8 hours, moderate to severe respiratory distress (FiO 2 ≥0.30 on nCPAP for SpO 2 ≥88% or Silverman score ≥6) Any kind of disease not allowing early extubation Abbreviations: AS, Apgar score; GA, gestational age; MV, mechanical ventilation; nCPAP, nasal continuous positive airway pressure; PEEP, positive end-expiratory pressure; PNA, postnatal age; PPROM, preterm premature rupture of membranes; RDS, respiratory distress syndrome. could not be extubated after surfactant administration and another 13 patients had to be reintubated. In 10 of these 15 patients the reason for INSURE failure was recurrent apnea. Information regarding the time frame between extubation and INSURE failure was lacking. 19 In another study Verder et al. found that four patients (7%) could not be extubated after surfactant administration. In two patients the reason was intractable apnea, which is a side effect of morphine. In this study the use of morphine was optional and the authors did not mention if these two patients had received morphine. 21 In the study of Bohlin et al., patients received a combination of 200 μg/kg morphine and 2 mg/kg pentobarbital prior to intubation. Naloxone 100 μg/kg was administered to all patients before extubation. Information regarding intubation conditions, number