Shalish Wissam, Sant'Anna Guilherme M
Department of Pediatrics, Division of Neonatology, Montreal Children's Hospital, McGill University Health Center, 1001 Boul. Décarie, Room B05.2714, Montreal, Quebec, H4A 3J1, Canada.
Semin Fetal Neonatal Med. 2023 Oct;28(5):101489. doi: 10.1016/j.siny.2023.101489. Epub 2023 Nov 18.
In neonatal intensive care, endotracheal intubation is usually performed as an urgent or semi-urgent procedure in infants with critical or unstable conditions related to progressive respiratory failure. Extubation is not. Patients undergoing extubation are typically stable, with improved respiratory function. The key elements to facilitating extubation are to recognize improvement in respiratory status, promote weaning of mechanical ventilation, and accurately identify readiness for removal of the endotracheal tube. Therefore, extubation should be a planned and well-organized procedure. In this review, we will appraise the evidence for existing predictors of extubation readiness and provide patient-specific, pathophysiology-derived strategies to optimize the timing and success of extubation in neonates, with a focus on extremely preterm infants.
在新生儿重症监护中，气管插管通常是作为一项紧急或半紧急操作，用于患有与进行性呼吸衰竭相关的危急或不稳定状况的婴儿。拔管则不然。接受拔管的患者通常病情稳定，呼吸功能有所改善。促进拔管的关键要素是识别呼吸状况的改善、促进机械通气的撤机，并准确判断拔除气管导管的时机。因此，拔管应是一个有计划且组织完善的过程。在本综述中，我们将评估现有拔管准备预测指标的证据，并提供基于患者个体、病理生理学的策略，以优化新生儿尤其是极早产儿拔管的时机和成功率。
