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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2012, Number 3

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Rev Invest Clin 2012; 64 (3)

Associated factors to extubation failure of neonates and infants with bronchopulmonary dysplasia

Tapia-Rombo CA, Hernández-Gutiérrez AL

Language: Spanish
References: 34
Page: 262-274
PDF size: 201.77 Kb.


ABSTRACT

Introduction. The extubation failure is a common problem in newborn (NB) and infants diagnosed with bronchopulmonary dysplasia (BPD), a situation that prolongs the mechanical ventilatory support (MVS) and increases the risk of further laryngotracheal and pulmonary damage that predisposes to fail in the procedure. There are no studies in the literature about this problem. Objective. To identify associated factors to extubation failure in newborns and infants with diagnosis of BPD. Material and methods. We retrospectively included all cases of newborns and infants with BPD who had been admitted to a neonatal intensive care unit (NICU) during the period January 2004 to June 2009 that met the selection criteria. Two groups the A, cases (extubation failure) and group B, controls (no extubation failure) were conformed. Inclusion criteria for both groups were preterm newborns of 28 to 36 weeks gestational age at birth (or corrected) or infants who had been with MVS at least 24 h and who had or does not extubation failure if so, at least on one occasion, both after the diagnosis of BPD in the first 72 h of being extubated and had no major malformations in any organ or system, with extra-uterine life up to 90 days. It was considered extubation failure when the NB or infant extubated after there need reintubated in the first 72 h, and was considered the second extubation failure under the same criteria after having failed the first extubation. Statistical analysis was performed using descriptive and inferential statistics. Significance levels were set at p ‹ 0.05. Results. The study population consisted of 89 patients who were divided into 2 groups: group A (cases) with 69 patients and group B (controls) with 20 patients. The characteristic of the population studied in both groups showed no significant differences between them with p › 0.05. In multivariate analysis before the first extubation showed statistically significant patent ductus arteriosus for cases with p = 0.01. Before the second extubation in the cases group versus before the first extubation in the control group showed also in the multivariate analysis statistical significance only peak inspiratory pressure (PIP) ≥ 14 cm H20 (in 3 of 69 cases and in 16 of 20 controls) (p ‹ 0.001), as a protective factor. Conclusions. Patients with BPD the extubation should be planned closure of the ductus arteriosus when present, even without hemodynamically significant and with ventilator parameters most demanding as PIP would be ≥ 14 cm H2O and moreover the latter in the second attempt at extubation, and to take into account other aspects known to decrease the incidence of extubation failure as far as possible, with improved prognosis.


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