Resumen

Introduction: The mechanical ventilatory 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: It was carried out a retrospective study, of case control 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 h. We take into account to patient of term NB of one to 28 days of extrauterine life that remained with MVS at least 24 h 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: the A (cases) of 17 patients and 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, the calories and the hemoglobin for controls and the time spent with MVS, reintubations number, and the peak inspiratory presure (PIP) prior to the passage of the CPAP for cases, all with p < 0.05. In the multivariate analysis, significant association was found as factor of risk for the extubation failure when the PIP was > 18 cm H₂O, ventilator rate > 15 x’ 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 cmH₂₀, ventilator rate < 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.

Palabras clave: Term newborn extubation failure mechanical ventilatory support.

2013-10-17   |   565 visitas   |   Evalua este artículo 0 valoraciones

Vol. 63 Núm.5. Septiembre-Octubre 2011 Pags. 484-493 Rev Invest Clin 2011; 63(5-ENGLISH)