Abstract：Objective To study the risk factors for the first ventilator weaning failure and the relationship between the weaning failure and prognosis in preterm infants receiving invasive mechanical ventilation. Methods A retrospective analysis was performed for the preterm infants who were admitted to the Neonatal Intensive Care Unit of Peking University Third Hospital and received mechanical ventilation within 72 hours after birth. According to whether reintubation was required within 72 hours after the first weaning, the infants were divided into a successful weaning group and a failed weaning group. Results A total of 282 preterm infants were enrolled, and there were 43 infants (15.2%) in the failed weaning group. Compared with the successful weaning group, the failed weaning group had significantly lower gestational age and birth weight (P < 0.05), a significantly higher rate of intubation in the delivery room (P < 0.05), and a significantly higher proportion of infants with patent ductus arteriosus (PDA; diameter ≥ 2.5 mm) (P < 0.05). Use of ≥ 2 vasoactive agents before ventilator weaning (OR=2.48, 95%CI:1.22-5.03, P < 0.05) and PDA (≥ 2.5 mm) (OR=4.54, 95%CI:2.02-10.24, P < 0.05) were risk factors for ventilator weaning failure. Compared with the successful weaning group, the failed weaning group had significantly higher incidence rates of ventilator-associated pneumonia, moderate-to-severe bronchopulmonary dysplasia, and sepsis (P < 0.05). The oxygen inhalation time and hospital stay in the failed weaning group were significantly longer than those in the successful weaning group (P < 0.05). Conclusions Use of ≥ 2 vasoactive agents before ventilator weaning and PDA (≥ 2.5 mm) are risk factors for ventilator weaning failure, and ventilator weaning failure may be associated with adverse outcomes in hospitalized preterm infants.
LIU Xiao-Yi,TONG Xiao-Mei. Risk factors for the first ventilator weaning failure in preterm infants receiving invasive mechanical ventilation[J]. CJCP, 2021, 23(6): 569-574.
Kapnadak SG, Herndon SE, Burns SM, et al. Clinical outcomes associated with high, intermediate, and low rates of failed extubation in an intensive care unit[J]. J Crit Care, 2015, 30(3):449-454. DOI:10.1016/j.jcrc.2015.02.005. PMID:25746585.
[2]
Chawla S, Natarajan G, Shankaran S, et al. Markers of successful extubation in extremely preterm infants, and morbidity after failed extubation[J]. J Pediatr, 2017, 189:113-119.e2. DOI:10.1016/j.jpeds.2017.04.050. PMID:28600154.
[3]
Venkataraman ST, Khan N, Brown A. Validation of predictors of extubation success and failure in mechanically ventilated infants and children[J]. Crit Care Med, 2000, 28(8):2991-2996. DOI:10.1097/00003246-200008000-00051. PMID:10966284.
[4]
Al-Hathlol K, Bin Saleem N, Khawaji M, et al. Early extubation failure in very low birth weight infants:clinical outcomes and predictive factors[J]. J Neonatal Perinatal Med, 2017, 10(2):163-169. DOI:10.3233/NPM-171647. PMID:28409751.
[5]
Manley BJ, Doyle LW, Owen LS, et al. Extubating extremely preterm infants:predictors of success and outcomes following failure[J]. J Pediatr, 2016, 173:45-49. DOI:10.1016/j.jpeds.2016.02.016. PMID:26960919.
[6]
Kidman AM, Manley BJ, Boland RA, et al. Predictors and outcomes of extubation failure in extremely preterm infants[J]. J Paediatr Child Health, 2021. DOI:10.1111/jpc.15356. PMID:33486799. Epub ahead of print.
Singh N, McNally MJ, Darnall RA. Does diaphragmatic electrical activity in preterm infants predict extubation success?[J]. Respir Care, 2018, 63(2):203-207. DOI:10.4187/respcare.05539. PMID:29184049.
[10]
Soonsawad S, Swatesutipun B, Limrungsikul A, et al. Heated humidified high-flow nasal cannula for prevention of extubation failure in preterm infants[J]. Indian J Pediatr, 2017, 84(4):262-266. DOI:10.1007/s12098-016-2280-2. PMID:28054235.
[11]
Amaro CM, Bello JA, Jain D, et al. Early caffeine and weaning from mechanical ventilation in preterm infants:a randomized, placebo-controlled trial[J]. J Pediatr, 2018, 196:52-57. DOI:10.1016/j.jpeds.2018.01.010. PMID:29519541.
[12]
Wang SH, Liou JY, Chen CY, et al. Risk factors for extubation failure in extremely low birth weight infants[J]. Pediatr Neonatol, 2017, 58(2):145-150. DOI:10.1016/j.pedneo.2016.01.006. PMID:27349301.
[13]
Jobe AH, Bancalari E. Bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med, 2001, 163(7):1723-1729. DOI:10.1164/ajrccm.163.7.2011060. PMID:11401896.
Papile LA, Burstein J, Burstein R, et al. Incidence and evolution of subependymal and intraventricular hemorrhage:a study of infants with birth weights less than 1,500 gm[J]. J Pediatr, 1978, 92(4):529-534. DOI:10.1016/s0022-3476(78)80282-0. PMID:305471.
[19]
周丛乐. 新生儿颅脑超声诊断学[M]. 北京:北京大学医学出版社, 2007:321-324.
[20]
Tracy MK, Berkelhamer SK. Bronchopulmonary dysplasia and pulmonary outcomes of prematurity[J]. Pediatr Ann, 2019, 48(4):e148-e153. DOI:10.3928/19382359-20190325-03. PMID:30986315.
[21]
Shalish W, Kanbar L, Keszler M. Patterns of reintubation in extremely preterm infants:a longitudinal cohort study[J]. Pediatr Res, 2018, 83(5):969-975. DOI:10.1038/pr.2017.330. PMID:29389921.
[22]
Brix N, Sellmer A, Jensen MS, et al. Predictors for an unsuccessful intubation-surfactant-extubation procedure:a cohort study[J]. BMC Pediatr, 2014, 14:155. DOI:10.1186/1471-2431-14-155. PMID:24947477.
[23]
Vrancken SL, van Heijst AF, de Boode WP. Neonatal hemodynamics:from developmental physiology to comprehensive monitoring[J]. Front Pediatr, 2018, 6:87. DOI:10.3389/fped.2018.00087. PMID:29675404.
[24]
Clark SJ, Yoxall CW, Subhedar NV. Right ventricular volume measurements in ventilated preterm neonates[J]. Pediatr Cardiol,2004,25(2):149-153. DOI:10.1007/s00246-003-0437-z. PMID:14708068.
[25]
Alkan Özdemir S, Arun Özer E, Bakiler AR, et al. Assessment of hemodynamic changes in preterm infants with respiratory distress syndrome[J]. Anatol J Cardiol,2017,18(6):440. DOI:10.14744/AnatolJCardiol, 2017.8148. PMID:29256886.
[26]
Jain D, Bancalari E. New developments in respiratory support for preterm infants[J]. Am J Perinatol, 2019, 36(S 02):S13-S17. DOI:10.1055/s-0039-1691817. PMID:31238352.
