Factors associated with extubation success in premature newborns submitted to spontaneous breathing test

Abstract

Introduction: Premature newborns (PTNBs) undergoing invasive mechanical ventilation (IMV) require special care, continuous bedside monitoring of respiratory parameters, respiratory mechanics, arterial gases and analysis of respiratory parameters in combination with graph curves.Although this ventilatory support is considered one of the greatest advances in medicine, prolonged stay is associated with an increase in mortality and morbidity, which makes weaning one of the priorities in these patients. Objective: The objective of this study is to analyze the factors associated with extubation success in PTNBs submitted to SBT. Methods: This study was observational, descriptive and retrospective. The PTNB analyzed were admitted to the Neonatal and Pediatric ICU of the Hospital do Trabalhador in the city of Curitiba. 110 PTNBs were recruited and all PTNBs who underwent the extubation bundle (n=27) during the period from July 2021 to June 2022 were included in the work, and data were collected from an IMV form and the factors following a bundle of extubation of the physiotherapy service of this unit, which were transcribed to an evolution form for analysis of the results with double checking. After meeting the criteria for successful extubation, which are included in the bundle: Parkin/Capurro, corrected gestational age, doses of pulmonary surfactant, NB weight, ventilatory data (dynamic compliance, pulmonary resistance, minute volume and tidal volume), pulmonary factors (gasometry data, X-ray, escape airway and drive/trigger present), cardiac factors (PCA with repercussion, X-ray, HP), neurological factors, clinical conditions, medications, ERT time and post-extubation ventilatory support, the TRE in all PTNB's of this research. Results: The summarized results demonstrate that the birth weight of the PTNB, its gestational age, the tidal volume in IMV, the plateau pressure, the NIPPV support used after extubation and the caffeine medication, presented a statistically significant difference in the success of extubation of these preterm infants ( p < 0.05). In addition, the statistical test (Fisher's Exact test) indicated the rejection of the null hypothesis (p=0.003), indicating that there is evidence that successful extubation is associated with a greater chance of not having reintubation. Discussion: There are many studied and factors that can indicate successful extubation, but the literature is still scarce when it comes to weaning protocols, successful extubation protocols and readiness tests to be used in PTNBs, thus requiring , of more studies likely to contribute to the decision of which moment and the favorable conditions to predict the success of extubation. Conclusion: Although much progress has been made in relation to the management of neonatal mechanical ventilation, there is still a long way to go in terms of building knowledge about the process of weaning and extubation of premature newborns. It is extremely important to continue the studies so that the evidence is sufficient to objectively determine ventilatory and clinical criteria and respiratory readiness tests with high predictive power and reproducibility between neonatal intensive care units, with the insertion of protocols systematized.