2011, Number 5
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Rev Invest Clin 2011; 63 (5)
Associated factors to extubation failure in the term newborns from a neonatal intensive care unit
Tapia-Rombo CA, Cortés-Ortiz RE, Uscanga-Carrasco H, Tena-Reyes D
Language: Spanish
References: 28
Page: 484-493
PDF size: 153.53 Kb.
ABSTRACT
Introduction. The mechanical ventilator support (MVS) it is a procedure which improves survival of critically ill newborns (NB), but is not risk free one of them is tracheal damage reintubations by extubation failure. Knowledge that there is the medical literature is about preterm infant and there is not information about term NB.
Objective. To establish that factors are associated to the unsuccessful extubation in the term NB from 37 to 42 weeks of gestational age.
Material and methods. Retrospective study, of casecontrol in cohort including all the files and/or patient term NB that were interned in the Neonatal Intensive Care Unit of a Neonatology Service during the period of January from the 2004 to December of 2008 that they fulfilled the selection criteria. They were formed two groups: group A of cases (extubation failure) and group B of controls (successful extubation). Extubation failure was considered when there was need for the patient reintubate during first 72 hrs. We take into account to patient of term NB of one to 28 days of extrauterine life that remained with MVS at least 24 hrs and that to extubate was achieved with or without success, previous step for tracheal continuous positive airway pressure (CPAP), and that they were not more than 28 days with MVS. The statistical analysis was carried out by means of the descriptive and the inferential statistic. It was considered area of significance with p ‹ 0.05.
Results. Fourty one patients were included divided in two groups: group A (cases) of 17 patients, and group B (controls) with 24 patients. The population’s characteristics studied among the two groups didn’t show significant differences. Of the variables studied between the two groups showed significant differences of age at start of ventilation, calories and the hemoglobin for controls and the time spent with MVS, reintubations number, and the peak inspiratory pressure ( PIP ) prior to the passage of the CPAP for cases, all with p ‹ 0.05. In the multivariate analysis they were significant association as factor of risk for the extubation failure when the PIP was › 18 cm H
2O, cycles › 15x’ and hemoglobin ‹ 13 g/dL.
Conclusions. Based on the above we conclude that in the term NB with MVS before placing in tracheal CPAP for the extubation should have a PIP ≤ 18 cm H
20, cycles ≤ 15x’ and a hemoglobin not smaller than 13 g/dL to avoid this way as much as possible the extubation failure and with it to improve the prognosis.
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