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首页> 外文期刊>Pediatrics Neonatology >Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants
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Risk Factors for Extubation Failure in Extremely Low Birth Weight Infants

机译：极低出生体重儿拔管失败的危险因素

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Background: Although antenatal steroids and early use nasal continuous positive airway pressure (NCPAP) have significantly improved outcomes of neonatal respiratory distress syndrome, intubation with ventilator support is still commonly required in extremely low birth weight (ELBW) infants. The optimal timing of extubation in ELBW infants remains unclear. Methods: We retrospectively analyzed all ELBW preterm infants who were admitted to our neonatal intensive care unit (NICU) from January 2009 to December 2013. Demographic, ventilation, and arterial blood gas analysis results prior to and 2 hours after extubation were collected. Extubation failure was defined as reintubation due to deterioration of respiratory condition within 7 days after extubation. Risk factors for extubation failure were analyzed. Results: In total, 173 ELBW infants were born and admitted to our NICU during these 5 years. Among these 173 infants, 77 (44.5%) used NCPAP only during their hospitalization (20 diagnosed with chronic lung disease (CLD), 25.9%). Among the 95 patients that required intubation, 27 patients expired so extubation was not attempted. Sixteen of 68 (23.5%) survival cases required reintubation within 7 days after extubation. We found that gestational age, birth body weight, and sex ratio did not differ between the successful extubation group and the failed extubation group. Univariate analysis showed that the failed extubation group had a lower arterial pH right before and 2 hours after extubation, with a lower bicarbonate level after extubation. Further multivariate logistic regression analysis revealed an association between poor acid-base homeostasis 2 hours after extubation (pH < 7.3 and HCO"3 < 18 mM/L) and extubation failure (odds ratio 4.56 and 6.187 and 95% confidence interval: 1.263~16.462 and 1.68~22.791, respectively). Conclusion: This study shows that nearly half of ELBW infants do not require intubation. Among ELBW infants who require invasive ventilator support, those who have lower postextubation arterial pH and bicarbonate levels are at high risk of extubation failure.
机译：背景：尽管产前类固醇和早期使用鼻持续气道正压通气（NCPAP）可以显着改善新生儿呼吸窘迫综合征的预后，但是对于极低出生体重（ELBW）的婴儿，仍普遍需要使用呼吸机进行插管。 ELBW婴儿拔管的最佳时机仍不清楚。方法：我们回顾性分析了2009年1月至2013年12月入院新生儿重症监护室（NICU）的所有ELBW早产儿。收集了拔管前和拔管后2小时的人口统计学，通气和动脉血气分析结果。拔管失败定义为拔管后7天内因呼吸状况恶化而重新插管。分析了拔管失败的危险因素。结果：在这5年中，总共有173名ELBW婴儿出生并被我们的NICU收治。在这173名婴儿中，有77名（44.5％）仅在住院期间使用了NCPAP（20名诊断为慢性肺病（CLD）的儿童为25.9％）。在需要插管的95例患者中，有27例已经过期，因此未尝试进行插管。 68例存活病例中有16例（占23.5％）需要在拔管后7天内重新插管。我们发现成功拔管组和失败拔管组的胎龄，出生体重和性别比没有差异。单因素分析显示，拔管失败组在拔管前和拔管后2小时的动脉pH较低，拔管后的碳酸氢盐水平较低。进一步的多因素logistic回归分析显示，拔管后2小时（pH <7.3和HCO“ 3 <18 mM / L）酸碱平衡不良与拔管失败（比值分别为4.56和6.187和95％置信区间：1.263〜16.462）相关结论：本研究表明近一半的ELBW婴儿不需要插管;在需要有创呼吸机支持的ELBW婴儿中，拔管后动脉pH和碳酸氢盐水平较低的婴儿有拔管失败的高风险。

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