Implementation of a Respiratory Therapist-Driven Protocol for Neonatal Ventilation: Impact on the Premature Population

Hermeto, Fernanda; Bottino, Marcela; Vaillancourt, Kelly; Sant’Anna, Guilherme M.

doi:10.1542/peds.2008-1647

“…Por outro lado, a extubação tardia, como discutido anteriormente, está associada à piora da lesão pulmonar e ao aumento dos marcadores inflamatórios. O aumento da atividade inflamatória, por sua vez, tem sido associado a uma maior incidência de HIC e à reabertura do canal arterial 22,26,27 .…”

Section: Resultados Secundáriosunclassified

“…Em nosso estudo, observamos uma diferença marcante, embora não significativa, na idade pós-natal à extubação (sucesso = 33 horas versus falha = 115 horas; p = 0,07). Recentemente demonstramos, numa população com PN e IG semelhantes, que a simples introdução de um protocolo de VM, com o estabelecimento de critérios para extubação e reintubação baseados em evidências, foi capaz de reduzir significativamente a incidência de falha na extubação em recém-nascidos desconectados mais precocemente (5 dias versus 1,2 dia) 22 .…”

Section: Desmame Da Vmunclassified

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

Hermeto

¹

,

Martins²,

Ramos³

et al. 2009

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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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“…Szymankiewicz et al 13 assessed the pulmonary mechanics of VLBW newborns evidence-based criteria for extubation and reintubation, was able to provide a significant reduction in the incidence of extubation failure in newborns who were extubated earlier (5 days vs. 1.2 day). 22 The use of methylxanthines also reduces time on MV, mainly in newborns with BW < 1,000 g who are extubated…”

Section: Risk Factorsmentioning

confidence: 99%

Incidência e principais fatores associados à falha de extubação em recém-nascidos com peso de nascimento < 1.250 gramas

Hermeto¹,

Martins²,

Ramos³

et al. 2009

J. Pediatr. (Rio J.)

Self Cite

40

0

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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 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.

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“…Several studies have failed to show a significant difference in subject outcomes between protocol and non-protocol RT. 2,3 However, Hermeto et al 4 found that protocol RT in the neonatal ICU significantly reduced weaning time in mechanically ventilated neonates compared with non-protocol RT. Similarly, protocol RT was found to reduce the duration of mechanical ventilation in adult subjects.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Therapist-Directed and Physician-Directed Respiratory Care in COPD Subjects With Acute Pneumonia

Werre

¹

,

Boucher

²

,

Beachey

³

2014

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BACKGROUND: The purpose of this retrospective medical record review was to compare the effects of therapist-directed (protocol RT) and physician-directed (non-protocol RT) respiratory therapy on hospital stay and 30-d post-discharge readmission in COPD subjects with acute bacterial pneumonia. METHODS: We reviewed 320 medical records; 244 records were usable. Information gathered included gender, age, RT protocol type (protocol RT or non-protocol RT), hospital stay, 30-d post-discharge readmission, and disease severity score. A 3-way analysis of variance and post hoc analysis were performed to determine the possible effects of disease severity, age, and RT protocol type on hospital stay and the possible interaction effects among these independent variables. A chi-square test for independence was computed to determine whether there was an association between RT protocol type and 30-d readmission. RESULTS: There were no significant interaction effects among RT protocol type, age, and disease severity on hospital stay. In addition, there were no significant effects of either RT protocol type (P ‫؍‬ .41) or age (P ‫؍‬ .85) on hospital stay in our subject sample. However, as expected, disease severity had a significant effect on hospital stay, increasing it by a mean of 2.6 d (95% CI 0.77-4.4, P ‫؍‬ .005). The chi-square test for independence revealed that the frequency of 30-d readmission was significantly associated with RT protocol type (P ‫؍‬ .02); fewer 30-d readmissions were associated with protocol RT. CONCLUSIONS: We interpreted the finding of no difference in mean hospital stay between protocol and nonprotocol RT to indicate that protocol RT did not confer a disadvantage to subjects in terms of hospital stay. Additionally, the results suggest that treatment efficacy is not sacrificed when RT is directed by respiratory therapists rather than by physicians regardless of disease severity and that therapist-directed protocols may have been of some benefit in reducing 30-d post-discharge readmission.

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Implementation of a Respiratory Therapist-Driven Protocol for Neonatal Ventilation: Impact on the Premature Population

Cited by 63 publications

References 25 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

Incidência e principais fatores associados à falha de extubação em recém-nascidos com peso de nascimento < 1.250 gramas

Comparison of Therapist-Directed and Physician-Directed Respiratory Care in COPD Subjects With Acute Pneumonia

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Implementation of a Respiratory Therapist-Driven Protocol for Neonatal Ventilation: Impact on the Premature Population

Cited by 63 publications

References 25 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

Incidência e principais fatores associados à falha de extubação em recém-nascidos com peso de nascimento < 1.250 gramas

Comparison of Therapist-Directed and Physician-Directed Respiratory Care in COPD Subjects With Acute Pneumonia

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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