Analysis of Respiratory Behavior and Clinical Parameters for Successful Extubation in Premature Infants

Authors

Department of Pediatrics, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.

Abstract

Background
The weaning process is complex and needs to be done carefully. The success of extubation in premature babies is associated with brain maturity and adequate function of the lungs. We aimed to identify the ventilator parameters and clinical conditions related to extubation success and failure in premature infants.
Materials and Methods
This is anobservational study, analytical and non-comparative cohort. We selected all premature infants, into inclusion criterion, admitted to the Neonatal Intensive Care Unit (NICU) of Hospital de Clínicas, Curitiba, Brazil in Invasive mechanical ventilation (IMV). The fifty-one premature infants were evaluated every day until tracheal extubation and the data of the day of extubation were used.
Results
Thirty-nine premature infants had extubation success and the majority of them 32(82.05%) were appropriated for gestational age (AGA). The parameters that showed a statistical difference between success and failure group were Positive end-expiratory pressure (p = 0.03), plate pressure (p = 0.03), Partial pressure oxygen (p = 0.04), pH (p = 0.04), end-tidal CO2 (p = 0.01) and heart rate (p = 0.04). The use of caffeine periextubation and the permanence in Continuous positive airway pressure (CPAP) during the post-extubation period was higher in the success group (46.15% and 87.18%, respectively). The presence of piratory distress syndrome (RDS) was high in both groups, success group, 82.05% and failure group 100%.
Conclusion
The pressure values, the arterial blood gas analyses, and capnometry are important parameters to evaluate in the weaning process, checking these values closer to reference values. Supports before and after endotracheal extubation, such as the use of caffeine and CPAP, are important to avoid the need for reintubation.

Keywords