Nussbaum Claudia, Lengauer Maximilian, Puchwein-Schwepcke Alexandra F, Weiss Veronique B N, Spielberger Benedikt, Genzel-Boroviczény Orsolya
Division of Neonatology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, 80337 Munich, Germany.
Department of Pediatric Neurology and Developmental Medicin, University of Basel Children's Hospital, 4056 Basel, Switzerland.
Children (Basel). 2022 Aug 26;9(9):1292. doi: 10.3390/children9091292.
The factors influencing weaning of preterm infants from noninvasive ventilation (NIV) are poorly defined and the weaning decisions are often driven by subjective judgement rather than objective measures. To standardize quantification of respiratory effort, the Silverman-Andersen Score (SAS) was included in our nursing routine. We investigated the factors that steer the weaning process and whether the inclusion of the SAS would lead to more stringent weaning. Following SAS implementation, we prospectively evaluated 33 neonates born ≤ 32 + 0 weeks gestational age. Age-, weight- and sex-matched infants born before routine SAS evaluation served as historic control. In 173 of 575 patient days, NIV was not weaned despite little respiratory distress (SAS ≤ 2), mainly due to bradycardias (60% of days without weaning), occurring alone (40%) or in combination with other factors such as apnea/desaturations. In addition, "soft factors" that are harder to grasp impact on weaning decisions, whereas the SAS overall played a minor role. Consequently, ventilation times did not differ between the groups. In conclusion, NIV weaning is influenced by various factors that override the absence of respiratory distress limiting the predictive value of the SAS. An awareness of the factors that influence weaning decisions is important as prolonged use of NIV has been associated with adverse outcome. Guidelines are necessary to standardize NIV weaning practice.
影响早产儿无创通气（NIV）撤机的因素尚不明确，撤机决策往往由主观判断而非客观指标驱动。为规范呼吸努力的量化评估，我们将西尔弗曼-安德森评分（SAS）纳入护理常规。我们研究了指导撤机过程的因素，以及纳入SAS是否会使撤机标准更严格。在实施SAS后，我们前瞻性评估了33例胎龄≤32+0周的新生儿。将在常规SAS评估前出生的年龄、体重和性别匹配的婴儿作为历史对照。在575个患者日中的173个日里，尽管呼吸窘迫轻微（SAS≤2），NIV仍未撤机，主要原因是心动过缓（60%未撤机的日子），单独出现（40%）或与其他因素如呼吸暂停/血氧饱和度下降同时出现。此外，较难把握的“软性因素”会影响撤机决策，而SAS总体作用较小。因此，两组的通气时间没有差异。总之，NIV撤机受多种因素影响，这些因素超越了呼吸窘迫的缺失，限制了SAS的预测价值。了解影响撤机决策的因素很重要，因为长时间使用NIV与不良结局相关。需要制定指南来规范NIV撤机实践。
