A randomized trial of delayed extubation for the reduction of reintubation in extremely preterm infants

Danan, Claude; Durrmeyer, Xavier; Brochard, Laurent; Decobert, Fabrice; Benani, M.; Dassieu, Gilles

doi:10.1002/ppul.20726

Cited by 41 publications

(33 citation statements)

References 23 publications

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“…Como ainda não existem medidas ou testes com sensibilidade e especificidade satisfatórias para predizer o momento ideal para extubação em recém-nascidos prematuros [11][12][13][14] , torna-se importante identificar os principais fatores associados à falha de extubação nessa população. O presente estudo tem como objetivo principal determinar a incidência e os principais fatores de risco associados à necessidade de reintubação em nossa unidade de terapia intensiva (UTI) neonatal, em uma população de recém-nascidos prematuros, rotineiramente extubados para CPAP nasal em selo d'água.…”

Section: Incidence and Main Risk Factors Associatedunclassified

“…Danan et al 12 , utilizando VM otimizada, adiaram essa primeira tentativa de extubação por 36 horas sem obter nenhuma melhora na taxa de sucesso. Thomson et al 21 compararam extubação em 24 horas com extubação no 5º dia de vida em macacos prematuros e demonstraram que os animais extubados mais tardiamente apresentaram aumento no número de apneias, no tempo de VM e na necessidade de oxigênio suplementar, com piora da lesão pulmonar e aumento dos marcadores inflamatórios.…”

Section: Desmame Da Vmunclassified

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

Hermeto

Martins²,

Ramos³

et al. 2009

J Pediatr (Rio J)

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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...

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Section: Incidence and Main Risk Factors Associatedunclassified

Section: Desmame Da Vmunclassified

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

Hermeto

Martins²,

Ramos³

et al. 2009

J Pediatr (Rio J)

View full text Add to dashboard Cite

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“…Extubation may be successful from a mean airway pressure of 6-7 cm H 2 O on conventional modes and from 8-9 cm H 2 O of CDP on HFOV, even in the most immature babies. Keeping stable very preterm babies on low rate MV for longer periods does not improve the chance of successful extubation [102] . Extubation to nasal CPAP reduces the risk of re-intubation (RR 0.62; 95% CI 0.49-0.77; NNT 6) [79] .…”

Section: Aggressive Weaning and New Modes Of Conventional Ventilationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update

Sweet

Carnielli²,

Greisen³

et al. 2010

Neonatology

232

175

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These updated guidelines contain new evidence from recent Cochrane reviews and the medical literature since 2007. Many of the previous recommendations regarding early surfactant and CPAP are now more firmly evidence-based. The section on delivery room stabilisation has been considerably expanded. There are new recommendations on delaying umbilical cord clamping and a new section has been added on avoiding or reducing duration of mechanica l ventilation, including recommendations on caf feine t herapy, nasal ventilation, permissive hypercapnia and the role of newer ventilator modalities. A new 'miscellaneous' section has also been added covering aspects of RDS management that arise infrequently.© For permitted use only.

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“…Extubation may be successful from 7-8 cm H 2 O mean arterial pressure on conventional modes and from 8-9 cm H 2 O continuous distending pressure on HFOV. Keeping stable very preterm babies on low-rate MV for longer periods does not improve the chance of successful extubation [104]. Extubating to a relatively higher level of CPAP pressure of 7- 9 cm H 2 O will improve the chance of successfully remaining off the ventilator [105].…”

Section: Mechanical Ventilation Strategiesmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

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Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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A randomized trial of delayed extubation for the reduction of reintubation in extremely preterm infants

Abstract: Adding 36 hr of optimized mechanical ventilation before first extubation does not improve the rate of successful extubation but has no adverse effects.

Cited by 41 publications

References 23 publications

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

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

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

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A randomized trial of delayed extubation for the reduction of reintubation in extremely preterm infants

Abstract: Adding 36 hr of optimized mechanical ventilation before first extubation does not improve the rate of successful extubation but has no adverse effects.

Cited by 41 publications

References 23 publications

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

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

European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants – 2010 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

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Product

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

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