极早产儿成功拔管的标志物及拔管失败后的发病率
Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation.
作者信息
Chawla Sanjay, Natarajan Girija, Shankaran Seetha, Carper Benjamin, Brion Luc P, Keszler Martin, Carlo Waldemar A, Ambalavanan Namasivayam, Gantz Marie G, Das Abhik, Finer Neil, Goldberg Ronald N, Cotten C Michael, Higgins Rosemary D
机构信息
Department of Pediatrics, Wayne State University, Detroit, MI.
Department of Pediatrics, Wayne State University, Detroit, MI.
出版信息
J Pediatr. 2017 Oct;189:113-119.e2. doi: 10.1016/j.jpeds.2017.04.050. Epub 2017 Jun 7.
OBJECTIVES
To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates.
STUDY DESIGN
This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 24 to 27 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation.
RESULTS
Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27).
CONCLUSIONS
Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT00233324.
目的
确定与选择性拔管成功相关的变量，并确定极早产儿拔管失败相关的新生儿发病率。
研究设计
本研究是对美国国立儿童健康与人类发展研究所新生儿研究网络的表面活性剂、正压通气和氧合随机试验的二次分析，该试验纳入了孕24至27周出生的极早产儿。患者被随机分为允许性通气策略组（持续气道正压通气组）或插管后早期使用表面活性剂组（表面活性剂组）。有预先设定的插管和拔管标准。拔管失败定义为拔管后5天内再次插管。
结果
试验中的1316例婴儿中，1071例符合条件；926例婴儿有拔管状态的数据；538例拔管成功，388例拔管失败。持续气道正压通气组的拔管成功率为50%（188/374），表面活性剂组为63%（350/552）。拔管成功与出生后5分钟Apgar评分较高、拔管前pH值较高、出生后24小时内及拔管前吸入氧峰浓度较低、拔管前二氧化碳分压较低以及经随机分组调整后非小于胎龄状态相关。拔管失败的婴儿经调整后的死亡率（比值比2.89）、支气管肺发育不良（比值比3.06）以及死亡/支气管肺发育不良（比值比3.27）发生率较高。
结论
出生后5分钟Apgar评分较高、拔管前pH值较高、出生后24小时内吸入氧峰浓度较低、拔管前二氧化碳分压和吸入氧分数较低以及非小于胎龄状态与拔管成功相关。拔管失败与死亡率和发病率显著升高相关。
试验注册
ClinicalTrials.gov：NCT00233324。
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