Predictive indices of ventilatory weanning in prematures: Literature review

Abstract

Objective: To describe the predictive indices for MV weaning in preterm infants. Methodology: This is a descriptive literature review, carried out in a bibliographic survey from July to September 2023, in articles published in the last 10 years, using the databases: National Library of Medicine (Pubmed), Scientific Electronic Library Online (SCIELO), Physiotherapy Evidence Databases (PEDro). RESULTS: Only three articles were selected for this review, showing that 56.5% of the newborns admitted to the NICU were male, with a mean GA of 25 to 36 weeks, birth weight of 754g to 1500g. Conclusion: The correct timing of weaning from mechanical ventilation and extubation is still considered a challenge in NICUs, where the scarcity of literature shows that further studies should be carried out in order to establish the best strategy for a possible success of extubation. Results: Gestational age ranges from 26 to 36 weeks and 6 days, birth weight from 882 g to 1500 g, APGAR score at 1' from 4.9 to 5.4 and at 5' from 6 to 8. In the clinical trials, the underlying diseases found were: In the first group, Respiratory Distress Syndrome (60.4-67.4%), preterm infants used Mechanical Ventilation from 27-29 hours, the number of deaths was 22 (50-53), and the following predictive indices were used: Evaluate: Pulmonary mechanics; Pressure-time index; Minute ventilation test; Clinical trials; and Dynamics of biological signals. In the randomized clinical trial. In group 2: Bronchopulmonary Dysplasia (30%); Intracranial hypertension (7.5%). Deaths in this group were 5.7% and the predictive indices used were: Higher APGAR score at 5 minutes; Higher pH (before extubation); Lowest peak FiO2 (in the first 24 hours of age); Lower PCO2 and FiO2 (before extubation); and Non-PIG status. Subgroup 2: Bronchopulmonary Dysplasia (64%); Intracranial hypertension (23%). Deaths in this group were 28% and the predictive index used was gestational age. And in the third study: Apnea 54.5%; SDR 18.1%; PCA: 5.5%. Days of mechanical ventilation was 2 days. The predictive indices used were: RR = 12 bpm; PIP = 16 cmH 2 0; PEEP = 6 cmH 2 0; FiO 2 ≤ 40%. In group 2 of the third study: Apnea: 16.6%; SDR 33.3%; PCA: 19.4%. Days of ventilation was 1 day and a half. The predictive indices used were: Pressure equal to .6 cmH 2 0; Oxygen Fraction from 2 ≤ 40%.

DOI:https://doi.org/10.56238/sevened2024.002-037