Nesbitt Gemma, Guy Katelyn J, König Kai
Department of Paediatrics, Mercy Hospital for Women, Melbourne, Australia.
Am J Perinatol. 2015 Sep;32(11):1059-63. doi: 10.1055/s-0035-1548536. Epub 2015 Apr 27.
Unplanned extubation (UE) occurs as an infrequent complication of mechanical ventilation in the neonatal intensive care unit (NICU). Following UE, a trial of noninvasive ventilation (NIV) may be considered if a neonate is showing adequate respiratory effort. This study investigated the success and failure rate of NIV management of neonates experiencing UE.
Retrospective single-center study of neonates experiencing UE in the NICU over a 9-year period. Reintubation within 12 hours of a trial of NIV following UE was defined as treatment failure. Short-term respiratory outcomes were analyzed for all infants plus the incidence of bronchopulmonary dysplasia for preterm infants born less than 32 weeks' gestation.
A total of 43 patients were included. Of those, 30 infants were trialed on NIV following UE. Baseline demographics were similar between both the groups except for the oxygen requirement before UE. The NIV was successful in 20 and failed in 10 infants. Infants who failed a trial of the NIV were reintubated between 0.45 and 5.25 hours following UE. Respiratory outcomes in very preterm infants did not differ between groups.
A trial of NIV may be considered as a treatment option in preterm and term newborns experiencing UE in the NICU.
非计划拔管（UE）是新生儿重症监护病房（NICU）机械通气时不常见的并发症。UE发生后，如果新生儿呼吸努力充分，可考虑进行无创通气（NIV）试验。本研究调查了NIV治疗新生儿UE的成功率和失败率。
对NICU 9年间发生UE的新生儿进行回顾性单中心研究。UE后NIV试验12小时内再次插管定义为治疗失败。分析了所有婴儿的短期呼吸结局以及孕周小于32周的早产儿支气管肺发育不良的发生率。
共纳入43例患者。其中，30例婴儿在UE后接受了NIV试验。除UE前的氧需求外，两组间的基线人口统计学特征相似。NIV治疗成功20例，失败10例。NIV试验失败的婴儿在UE后0.45至5.25小时内再次插管。极早产儿的呼吸结局在两组间无差异。
对于NICU中发生UE的早产儿和足月儿，可考虑进行NIV试验作为一种治疗选择。
