Ventilatory weaning in premature newborns: evaluation of the SBT with CPAP-PS method

Abstract

Introduction: Determining the ideal time for weaning from mechanical ventilation and extubation remains a challenge in neonatal intensive care units. The process of withdrawing ventilatory support is a critical step and is associated with complications and mortality. Therefore, reducing the time on mechanical ventilation, early identifying newborns capable of breathing spontaneously through the spontaneous breathing test and observing the variables that predict the success of ventilatory weaning could minimize risks and complications. The spontaneous breathing test (SBT) before extubation provides information about the ability to breathe spontaneously, but little research has been carried out to validate it in neonatology. Objective: To evaluate the effectiveness of the spontaneous breathing test with the CPAP-PS mode on the success of extubation of premature newborns compared to the standard protocol that uses the reduction of respiratory parameters. As secondary objectives, it was verified whether the support pressure associated with tracheal CPAP is a predictive variable for success in the extubation of premature newborns and identification of the variables associated with the success of ventilatory weaning in preterm infants. Methods: Observational retrospective cohort study, through review of medical records and physiotherapy shift handover spreadsheet of premature newborns admitted to a Neonatal ICU in the city of Duque de Caxias/RJ, from January 2019 to October 2021, undergoing invasive mechanical ventilation and the extubation procedure after a spontaneous breathing test in CPAP-PS mode or the standard protocol for reducing ventilatory parameters. 296 newborns participated in this study, divided into two groups, with group I consist of preterm infants exposed to TRE CPAP-PS and group II consisting of extubated preterm infants following the standard protocol for reducing ventilatory parameters. Results: Newborns subjected to weaning in TRE CPAP-PS mode have a higher probability of successful extubation when compared to those who were extubated with the standard protocol of reducing ventilatory parameters, being statistically significant (p < 0.001). Discussion: The study evaluated the success rate of extubation using the TRE CPAP-PS method, and compared between the two
methods, the time until weaning, survival and time until discharge in each of the groups, and the results found suggest that the Ventilatory weaning of PTNBs conducted using CPAP - PS presents significantly better outcomes in relation to the usual parameter reduction weaning. Conclusion: The outcome of weaning and extubation of PTNBs submitted to SBT with the CPAP-PS mode showed a higher success rate, lower mortality rate and shorter time to discharge, when compared to PTNBs exposed to weaning with the standard protocol with reduced ventilation parameters. Technological advances and intensive care processes aimed at the neonatal population, including accurate graphic monitoring and new ventilation modalities, make it possible to apply the respiratory readiness test in an effective and reproducible way, as demonstrated in this study and reinforce the importance of continuing with
controlled studies and randomized with this SBT modality compared to other SBT modalities, in order to establish a gold standard ventilatory weaning protocol in neonatology.