Incidence and main risk factors associated with extubation failure in newborns with birth weight < 1,250 grams

Abstract

Objectives: To determine the incidence of extubation failure in preterm newborns with birth weight < 1,250 g extubated to nasal continuous positive airway pressure and to identify the main risk factors associated with the need for reintubation in this population. Methods:A retrospective review of eligible infants admitted and mechanically ventilated between July 2002 and June 2004 was performed. Extubation failure was defined as the need for reintubation within 7 days after the first extubation attempt. Results:Of the 52 patients included in the study, 13 died before the first extubation attempt. Of the remaining 39 patients, only nine had failed extubation (23.1%) Comparing the two groups (failure vs. successful), there was a statistically significant difference regarding birth weight, gestational age and 5-minute Apgar score. After logistic regression, only gestational age was significant. Other secondary outcomes showed significant difference between the groups: intracranial hemorrhage grade III and/or IV, patent ductus arteriosus and death. Conclusions:The incidence of extubation failure in our population was similar to the rate reported in the literature. The main risk factor for extubation failure was prematurity (≤ 28 weeks). In this population of extreme preterm infants, implementation of strategies for early extubation, use of methylxanthines, prevention of patent ductus arteriosus, and use of different modes of assisted ventilation after extubation may improve the outcomes.J Pediatr (Rio J). 2009;85(5):397-402: Prematurity, mechanical ventilation, extubation failure, bronchopulmonary dysplasia. ResumoObjetivos: Determinar a incidência de falha de extubação em recém-nascidos prematuros com peso de nascimento < 1.250 g extubados para pressão positiva contínua nas vias aéreas nasais e identificar os principais fatores de risco que possam estar associados à necessidade de reintubação nessa população.Métodos: Análise retrospectiva dos prontuários de pacientes internados e ventilados mecanicamente durante o período de julho de 2002 a junho de 2004. Falha na extubação foi definida como necessidade de reintubação nos primeiros 7 dias após a primeira tentativa de extubação.Resultados: Entre 52 pacientes estudados, 13 faleceram antes da primeira tentativa de extubação. Do restante, apenas nove falharam na extubação (23,1%). Comparando esses recém-nascidos com aqueles extubados com sucesso, houve diferença estatisticamente significativa em relação a peso de nascimento, idade gestacional e escore de Apgar no 5º minuto. Após a regressão logística, apenas a idade gestacional se manteve significativa. Alguns resultados secundários também foram significativamente diferentes: incidência de hemorragia intracraniana graus III e/ou IV, persistência do canal arterial e óbito. Conclusões:Nosso estudo demonstrou uma incidência de falha na extubação semelhante à da literatura. O principal fator de risco para falha nessa população foi a prematuridade (≤ 28 semanas). Nesses prematuros extremos, a implementação de estrat...

Avaliação do teste de respiração espontânea na extubação de neonatos pré-termo

“…These data have show increased extubation failure risk for higher FiO 2 and lower current body weight. Hermeto et al (15) have shown a 23% extubation failure rate in a population with birth weight < 1,250 g and 35% with birth weight < 1,000 g. Additionally, the Dimitriou et al (4) study has shown that neonates with lower birth weight (among other factors) and pre-extubation higher FiO 2 were associated with extubation failure.…”

“…This stresses the relevance of predictive tests identification and use, aiming a better identification of the best time for extubation, thus reducing the MV duration, its deleterious effects, and later reintubation requirements. (14,15,18,26) The success in the 30 minutes test with CPAP ventilatory mode may reflect the neonate ability to spontaneously breathe with no significant clinical changes, as shown for the maintenance of the clinical parameters (HR, RR, SpO 2 and SAS).…”

“…(12)(13)(14) If the extubation failure could be accurately predicted, the extubation could be better scheduled, and the reintubation trauma prevented. (15,16) During the last decade, the studies have focused on strategies for shortening the MV duration, including the early identification of candidates to spontaneously breathe using the spontaneous breathing trial (SBT), and methods to predict extubation success or failure. (14,16) The search for physiological accurate and reproducible indicators, able to predict the extubation success, has so far not reached satisfactory results, as no reported indicator was consistently able to predict success in neonates.…”

“…(14,16) The search for physiological accurate and reproducible indicators, able to predict the extubation success, has so far not reached satisfactory results, as no reported indicator was consistently able to predict success in neonates. (15)(16)(17)(18) The SBT is a simple technique performed immediately before the extubation and may provide useful information on the patient's spontaneous breathing ability. (10,19) This test is already common and well founded in adult and pediatric intensive care units (ICUs), however, few studies were developed to validate its neonatal use.…”

Extubation failure in the very preterm infant

“…A contribuição de Hermeto et al 1 , publicada nesta edição do Jornal de Pediatria, confirma que os bebês com menor idade gestacional estão mais propensos a insucesso na extubação; os outros fatores investigados pelos autores não constituíram preditores independentes de insucesso na extubação. O estudo também revelou que o insucesso na extubação está associado a hemorragia intracraniana grave e persistência do canal arterial.…”