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Ventilator variables predicting extubation readiness in extremely premature infants with prolonged mechanical ventilation: A retrospective observational study.
Nguyen, Truong An; Matousek, Josef; Kubena, Ales; Resl, Kilián; Kudrna, Petr; Dunajová, Klára; Plavka, Richard.
Afiliación
  • Nguyen TA; Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Matousek J; Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Kubena A; Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Resl K; Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Kudrna P; Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic.
  • Dunajová K; Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
  • Plavka R; Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine Charles University and General University Hospital in Prague, Prague, Czech Republic.
Pediatr Pulmonol ; 2024 Sep 12.
Article en En | MEDLINE | ID: mdl-39267451
ABSTRACT

BACKGROUND:

The current generation of neonatal ventilators enables periodic storage of set, measured, and calculated ventilatory parameters.

DESIGN:

Retrospective observational study.

OBJECTIVES:

To evaluate and identify the ventilatory, demographic, and clinical pre-extubation variables that are significant for estimating extubation readiness.

METHODS:

Eligible subjects included premature infants <33 weeks of gestation weaned from mechanical ventilation (MV) lasting >24 h. A total of 16 relevant ventilator variables, each calculated from 288 data points over 24 h, together with eight demographic and three clinical pre-extubation variables, were used to create the generalized linear model (GLM) for a binary outcome and the Cox proportional hazards model for time-to-event analysis. The achievement of a 120-h period without reintubation was defined as a successful extubation attempt (EA) within the binary outcome.

RESULTS:

We evaluated 149 EAs in 81 infants with a median (interquartile range) gestational age of 25+2 (24+3-26+1) weeks. Of this, 90 EAs (60%) were successful while 59 (40%) failed. GLM identified dynamic compliance per kilogram, percentage of spontaneous minute ventilation, and postmenstrual age as significant independent positive variables. Conversely, dynamic compliance variability emerged as a significant independent negative variable for extubation success. This model enabled the creation of a probability estimator for extubation success with a good proportion of sensitivity and specificity (80% and 73% for a cut-off of 60%, respectively).

CONCLUSIONS:

Ventilator variables reflecting lung mechanical properties and the ability to spontaneously breathe during MV contribute to better prediction of extubation readiness in extremely premature infants with chronic lung disease.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pediatr Pulmonol Asunto de la revista: PEDIATRIA Año: 2024 Tipo del documento: Article País de afiliación: República Checa Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pediatr Pulmonol Asunto de la revista: PEDIATRIA Año: 2024 Tipo del documento: Article País de afiliación: República Checa Pais de publicación: Estados Unidos