Risk factors associated with failure of extubation in very-low-birth-weight newborns

Spasojević, Slobodan; Doronjski, Aleksandra

doi:10.1080/14767058.2017.1285884

Cited by 9 publications

(20 citation statements)

References 20 publications

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“…Thirteen studies were considered potentially relevant and were analyzed completely. After a complete reading, 7 studies were excluded: 2 did not perform a structured SBT (ie, they did not establish passed/failed criteria in a readiness test), 20,21 1 study had data that were inconsistent for the outcome, 22 2 studies did not followup on outcomes (re-intubation rate) of neonates who failed the SBT and considered them as a weaning failure, 23,24 and 2 studies that compared rates of extubation success between a SBT group and a control group who did not perform the test. 25,26 Finally, 6 studies satisfied the eligibility criteria and were included in our systematic review and meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis

et al. 2020

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BACKGROUND: Few data are available on the use of spontaneous breathing trials (SBTs) in the neonatal population, despite advocacy of the practice in many neonatal ICUs. In this metaanalysis, we systematically reviewed the literature regarding the accuracy of SBTs as a predictor for extubation failure in premature infants. METHODS: Following the PRISMA recommendations, scientific articles were collected in December 2019 and January 2020 using PubMed, LILACS, Web of Science, Scopus, Google Scholar, OATD, and BDTD databases. The risk of bias in the studies included herein was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity and specificity of the studies were estimated using a mixed logistic regression model of 2 levels and a normal bivariate model. RESULTS: Six studies were included for qualitative and quantitative evaluation in this study. All SBTs were performed with endotracheal CPAP, with a total observation time of 3-5 min. The parameters for passing/failing the test were similar in 5 of the 6 studies and included bradycardia or desaturation during the test. The SBT showed a high pooled sensitivity (0.97, 95% CI 0.85-0.99), indicating proper identification of neonates "ready" for successful extubation. However, a low pooled specificity (0.40, 95% CI 0.24-0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. Heterogeneity of included studies was considerable for sensitivity and substantial for specificity. CONCLUSIONS: The SBT in premature infants can accurately predict extubation success but not extubation failure. Therefore, even though it is an attractive, practical, and easy-to-perform bedside assessment tool, there is a lack of evidence to support its use as an independent predictor of extubation failure in premature infants. Its routine use should be evaluated and monitored carefully.

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Section: Resultsmentioning

confidence: 99%

Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis

et al. 2020

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“…Also, new ventilation modalities enable to wean patients automatically (36,37). Several ways to assess extubation readiness have been studied in neonates, using respiratory scores and measurements (38,39).…”

Section: Discussionmentioning

confidence: 99%

Protocolized Versus Nonprotocolized Weaning to Reduce the Duration of Invasive Mechanical Weaning in Neonates

Bol

Zanten

Wielenga

et al. 2020

Journal of Perinatal &Amp; Neonatal Nursing

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“…Succes of extubation is also associated with preextubation ventilatory parameters including ventilatory rate, PIP, PEEP, MAP and FiO 2 . Spasojevic et al (26) showed that PIP of 18.4 cmH 2 O was better than PIP of 16.7 cmH 2 O on preventing extubation faiure without significant difference in very-low birthweight newborns. Tapia-Rombo et al (27) reported that PIP should be ≥14 cmH 2 O to attempt extubation in preterm infants with BPD.…”

Section: Discussionmentioning

confidence: 99%

Non-synchronized nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) after extubation in preterm infants with respiratory distress syndrome

İlhan¹,

Özdemir²,

Akbay³

et al. 2019

BUCH

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Objective: To determine whether non-synchronized nasal intermittent positive pressure ventilation (NIPPV) reduces the rates of extubation failure, compared to nasal continuous positive airway pressure (NCPAP), in preterm infants with respiratory distress syndrome (RDS). Method: This retrospective study included a total of 49 premature infants who were born at <32 gestational weeks with a birth weight of <1.500 g and required intubation due to RDS. The patients were followed up with NIPPV or NCPAP after extubation. The primary outcome was extubation failure within 48 hrs of extubation, while the secondary outcome was neonatal morbidities. Results: A total of 23 patients received NCPAP and 26 patients NIPPV following extubation. Demographic characteristics were similar in both NCPAP and NIPPV groups. Extubation failure was observed in five (21.7%) NCPAP, and in nine (34.6%) NIPPV patients, although any statistically significant intergroup difference was not detected (p=0.32). There were no significant intergroup differences as for post-extubation atelectasis, pneumothorax. Neonatal morbidities and mortality rates. However, the incidence of patent ductus arteriosus was statistically significantly higher in the NIPPV group (p<0.05). In none of the patients gastric or intestinal perforations were observed. Conclusion: It was concluded that NIPPV is not superior to NCPAP performed in preterm infants after extubation in reducing the incidence of reintubation and respiratory morbidities, including pneumothorax and post-extubation atelectasis.

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Risk factors associated with failure of extubation in very-low-birth-weight newborns

Abstract: Measured TV, SpO/FiO ratio, SBT at the moment of extubation and values of SAS starting 1 h after extubation might be valuable parameters in identifying those VLBW newborns in the risk to fail extubation.

Cited by 9 publications

References 20 publications

Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis

Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis

Protocolized Versus Nonprotocolized Weaning to Reduce the Duration of Invasive Mechanical Weaning in Neonates

Non-synchronized nasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) after extubation in preterm infants with respiratory distress syndrome

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