Development and validation of an extubation readiness assessment tool and accuracy to predict successful extubation in preterm infants

The purposes of this study were to examine appropriate parameters in the assessment tool for extubation readiness in preterm infants with endotracheal intubation and mechanical ventilation (MV) and to validate the assessment tool for extubation readiness in preterm infants with endotracheal intubation and MV. This research also examined the incidence of preterm infants with respiratory distress syndrome (RDS) and identify factors predicting survival of preterm infants with RDS hospitalized in neonatal intensive care units during 2016 to 2019. Retrospective cohort study was used for this study. Samples were divided into three groups; the group for studying the development and validation the assessment tool for extubation readiness which were 520 Electronic Health Records (EHRs) of mechanically intubated preterm infants hospitalized in the target hospital, the group for studying the incidence of RDS in preterm infants which were 820 EHRs of every preterm hospitalized in the target hospital, and the group for identifying factors predicting survival of preterm infants with RDS which were 362 cases. Steps of developing and validating an assessment tool for extubation readiness in preterm infants followed the concept of Burns and Grove (2005) and Srisatidnarakul (2012). Content validity of the tool was .94, intraclass correlation reliability was .99 and Cronbach’s alpha coefficient was .997. Binary logistic regression and Receiver Operator Characteristic (ROC) analysis were applied to predict appropriate parameters to assess the readiness for exubation. Moreover, incidence rate was used to identify the incidence of RDS in preterm infants and logistic regression was used to identify factors predicting survival of preterm infants with RDS. The results of developing and validating the assessment tool for extubation readiness revealed that seven indicators, consisting of pH, PCO2, Hct, Temperature, O2 saturation, MAP, and air entry, could be predictors to assess the extubation readiness in preterm infants. Moreover, area under the curve (AUC) of this assessment tool was at .893 with sensitivity of 84.3%, specificity of 81.0% and cut-off value of .62. For studying the incidence of preterm infants with RDS, the results revealed that 44.15 percent of preterm infants was diagnosed RDS and preterm infants with moderate RDS had the highest incidene (18.66%). Factors predicting survival of preterm infants with RDS were birth weight and LOS. This assessment tool for extubation readiness in preterm infants might be able to be a simple and useful tool for NICU nurses to assess the extubation readiness in preterm infants with endotracheal intubation and MV.