Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Tipo de documento: | Tese |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFS |
Texto Completo: | http://ri.ufs.br/jspui/handle/riufs/17130 |
Resumo: | Spontaneous Breathing Trials (SBT) have been used to evaluate extubation readiness in Neonatal Intensive Care Units (NICU), aiming to improve successful extubation rates in preterm infants. However, studies about SBT in the neonatal population are still scarce, especially regarding the ideal duration of the test. Thus, this thesis had two objectives: I) to systematically review the literature about the accuracy of SBT as a predictor for extubation failure in preterm infants; and II) to evaluate the effects of a 5-minutes SBT and a 10-minutes SBT on successful extubation rates of very low birth weight (VLBW) infants compared to clinical judgment alone. The proposed methods involved a systematic review of the literature with meta-analysis and a double-blind randomized controlled clinical trial (RCT). The systematic review included six studies for qualitative and quantitative analysis, which performed the SBT with 3 or 5 minutes, using the endotracheal continuous positive airway pressure (ET-CPAP) mode and positive end-expiratory pressure (PEEP) equivalent to conventional ventilation. In these studies, the SBT showed a high pooled sensitivity (0.97; 95% CI 0.85-0.99), demonstrating that most of the infants that had a successful extubation were correctly identified by an approved test, but a low pooled specificity (0.40, 95% CI 0.24–0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. In the RCT, 88 VLBW infants from two NICU of Alagoas were randomized into three groups: control group, 5-minutes SBT group and 10-minutes SBT group. SBT was performed under ET-CPAP mode with PEEP 5 cmH2O, inspiratory flow 10 L/min and FiO2 of 30%. Test failure was determined if the infant had, at any time during the test: bradycardia lasting longer than 15 seconds, and/or dessaturation for more than 15 seconds; and/or signs of respiratory distress with a Silverman Andersen Respiratory Severity Score higher than 5. The primary outcome was successful extubation rate, defined as no need for reintubation within 7 days after extubation. The results showed no difference among the three groups in relation to the proportion of successful extubation rate (p = 0.644), bronchopulmonary dysplasia occurrence (p = 0.790) and hospital length stay (p = 0.175). In general, both the systematic review and the RCT performed here do not support the use of SBT in premature infants as the main criterion in the final decision to extubate it. The passed test may be accompanied by many false positives, not correctly identifying the infants that could fail in the extubation, and adding little value to the clinical judgment. On the other hand, a failed test may be more useful in clinical practice, since the probability of having a successful extubation in failed test infants has decreased. This may serve as a warning to the clinical team, stimulating the infant´s reevaluation, identifying the possible causes of this failure and judging the cost-benefit of postponing extubation. |
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Teixeira, Raphaela FariasMedeiro, Andrea Monteiro CorreiaKassa, Samir Buainain2023-02-14T18:25:21Z2023-02-14T18:25:21Z2020TEIXEIRA, Raphaela Farias. Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros. 2020. 81 f. Tese (doutorado em Ciências da Saúde) – Universidade Federal de Sergipe, Aracaju, 2020.http://ri.ufs.br/jspui/handle/riufs/17130Spontaneous Breathing Trials (SBT) have been used to evaluate extubation readiness in Neonatal Intensive Care Units (NICU), aiming to improve successful extubation rates in preterm infants. However, studies about SBT in the neonatal population are still scarce, especially regarding the ideal duration of the test. Thus, this thesis had two objectives: I) to systematically review the literature about the accuracy of SBT as a predictor for extubation failure in preterm infants; and II) to evaluate the effects of a 5-minutes SBT and a 10-minutes SBT on successful extubation rates of very low birth weight (VLBW) infants compared to clinical judgment alone. The proposed methods involved a systematic review of the literature with meta-analysis and a double-blind randomized controlled clinical trial (RCT). The systematic review included six studies for qualitative and quantitative analysis, which performed the SBT with 3 or 5 minutes, using the endotracheal continuous positive airway pressure (ET-CPAP) mode and positive end-expiratory pressure (PEEP) equivalent to conventional ventilation. In these studies, the SBT showed a high pooled sensitivity (0.97; 95% CI 0.85-0.99), demonstrating that most of the infants that had a successful extubation were correctly identified by an approved test, but a low pooled specificity (0.40, 95% CI 0.24–0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. In the RCT, 88 VLBW infants from two NICU of Alagoas were randomized into three groups: control group, 5-minutes SBT group and 10-minutes SBT group. SBT was performed under ET-CPAP mode with PEEP 5 cmH2O, inspiratory flow 10 L/min and FiO2 of 30%. Test failure was determined if the infant had, at any time during the test: bradycardia lasting longer than 15 seconds, and/or dessaturation for more than 15 seconds; and/or signs of respiratory distress with a Silverman Andersen Respiratory Severity Score higher than 5. The primary outcome was successful extubation rate, defined as no need for reintubation within 7 days after extubation. The results showed no difference among the three groups in relation to the proportion of successful extubation rate (p = 0.644), bronchopulmonary dysplasia occurrence (p = 0.790) and hospital length stay (p = 0.175). In general, both the systematic review and the RCT performed here do not support the use of SBT in premature infants as the main criterion in the final decision to extubate it. The passed test may be accompanied by many false positives, not correctly identifying the infants that could fail in the extubation, and adding little value to the clinical judgment. On the other hand, a failed test may be more useful in clinical practice, since the probability of having a successful extubation in failed test infants has decreased. This may serve as a warning to the clinical team, stimulating the infant´s reevaluation, identifying the possible causes of this failure and judging the cost-benefit of postponing extubation.Testes de Respiração Espontânea (TRE) têm sido utilizados para avaliar a prontidão para extubação em Unidades de Terapia Intensiva Neonatal (UTIN), visando melhorar as taxas de sucesso na extubação dos recém-nascidos (RN). No entanto, ainda são escassos os estudos sobre o TRE na população neonatal, principalmente com relação ao tempo ideal de duração do teste. Dessa forma, esta tese teve dois objetivos específicos: I) revisar sistematicamente a literatura sobre a acurácia do TRE como preditor de falha na extubação de recém-nascidos pré-termos (RNPT); e II) avaliar os efeitos de um TRE de 5 minutos e um TRE de 10 minutos nas taxas de sucesso na extubação de recém-nascidos muito baixo peso (RNMBP), comparado ao julgamento clínico isolado. A metodologia proposta envolveu uma revisão sistemática da literatura com metanálise e um ensaio clínico randomizado (ECR) controlado duplo cego. Na revisão sistemática, foram incluídos seis estudos para análise qualitativa e quantitativa, que realizaram o TRE com 3 ou 5 minutos, utilizando o modo pressão positiva contínua em vias aéreas endotraqueal (ET-CPAP) e pressão positiva expiratória final (PEEP) equivalente a da ventilação convencional. Nesses estudos, o TRE mostrou uma elevada sensibilidade combinada (0.97; IC 95% 0.85-0.99), demonstrando que a maioria dos RN que tiveram uma extubação bem sucedida foram corretamente identificados por um teste aprovado, mas uma baixa especificidade combinada (0.40; IC 95% 0.24-0.58), indicando que muitos falsos positivos podem ocorrer, classificando erroneamente os RN que poderiam falhar no processo de extubação. No ECR, participaram 88 RNMBP de duas UTIN do estado de Alagoas, alocados em três grupos: grupo controle, grupo TRE 5-minutos e grupo TRE 10-minutos. O TRE foi realizado com o modo ET-CPAP com PEEP de 5 cmH2O, fluxo inspiratório de 10 L/min e FiO2 de 30%. Os critérios de reprovação do teste foram bradicardia por mais de 15 segundos, dessaturação por mais de 15 segundos e aumento do esforço respiratório com um Boletim de Silverman-Andersen maior que 5. O desfecho primário foi a taxa de sucesso na extubação, definida como a não necessidade de reintubar em até sete dias subsequentes a extubação. Os resultados não evidenciaram diferenças entre os três grupos em relação à proporção de sucesso na taxa de extubação (p = 0.644), incidência de displasia broncopulmonar (p = 0.790) e tempo total de internamento (p = 0.175). De forma geral, tanto a revisão sistemática com o ECR aqui realizados não apoiam o uso do TRE em RNPT como critério principal na decisão final de extubá-lo. A aprovação no teste pode ser acompanhada de muitos falsos positivos, não identificando corretamente os RN que poderiam falhar, e agregando pouco valor ao julgamento clínico dos profissionais. Já a reprovação no teste pode ter mais validade na prática clínica, uma vez a probabilidade de ter uma extubação bem sucedida nos RN reprovados diminuiu. Isso pode servir de alerta para equipe, estimulando a reavaliação do RN, buscando-se entender as possíveis causas dessa reprovação e julgando-se o custo-benefício de se adiar a extubação.AracajuporDesmame do respiradorExtubaçãoRecém-nascido de baixo pesoRecém-nascido prematuroRespiração artificialTerapia intensiva neonatalVentilator weaningExtubationInfant low birth weight.Infant prematureRespiration artificialIntensive care neonatal.CIENCIAS DA SAUDETeste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematurosinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisPós-Graduação em Ciências da SaúdeUniversidade Federal de Sergipereponame:Repositório Institucional da UFSinstname:Universidade Federal de Sergipe (UFS)instacron:UFSinfo:eu-repo/semantics/openAccessLICENSElicense.txtlicense.txttext/plain; charset=utf-81475https://ri.ufs.br/jspui/bitstream/riufs/17130/1/license.txt098cbbf65c2c15e1fb2e49c5d306a44cMD51ORIGINALTESE_RAPHAELA_FARIAS_TEIXEIRA.pdfTESE_RAPHAELA_FARIAS_TEIXEIRA.pdfapplication/pdf5782611https://ri.ufs.br/jspui/bitstream/riufs/17130/2/TESE_RAPHAELA_FARIAS_TEIXEIRA.pdf6f95be3e4f97633aaa1f7ac539010110MD52TEXTTESE_RAPHAELA_FARIAS_TEIXEIRA.pdf.txtTESE_RAPHAELA_FARIAS_TEIXEIRA.pdf.txtExtracted texttext/plain121152https://ri.ufs.br/jspui/bitstream/riufs/17130/3/TESE_RAPHAELA_FARIAS_TEIXEIRA.pdf.txt9a7cff5561a1214c9700bc5c1f691d86MD53THUMBNAILTESE_RAPHAELA_FARIAS_TEIXEIRA.pdf.jpgTESE_RAPHAELA_FARIAS_TEIXEIRA.pdf.jpgGenerated Thumbnailimage/jpeg1178https://ri.ufs.br/jspui/bitstream/riufs/17130/4/TESE_RAPHAELA_FARIAS_TEIXEIRA.pdf.jpg18a0d128efaef0c2dd2dd6ac27aebf11MD54riufs/171302023-02-14 15:25:21.326oai:ufs.br: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Repositório InstitucionalPUBhttps://ri.ufs.br/oai/requestrepositorio@academico.ufs.bropendoar:2023-02-14T18:25:21Repositório Institucional da UFS - Universidade Federal de Sergipe (UFS)false |
dc.title.pt_BR.fl_str_mv |
Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros |
title |
Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros |
spellingShingle |
Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros Teixeira, Raphaela Farias Desmame do respirador Extubação Recém-nascido de baixo peso Recém-nascido prematuro Respiração artificial Terapia intensiva neonatal Ventilator weaning Extubation Infant low birth weight. Infant premature Respiration artificial Intensive care neonatal. CIENCIAS DA SAUDE |
title_short |
Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros |
title_full |
Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros |
title_fullStr |
Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros |
title_full_unstemmed |
Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros |
title_sort |
Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros |
author |
Teixeira, Raphaela Farias |
author_facet |
Teixeira, Raphaela Farias |
author_role |
author |
dc.contributor.author.fl_str_mv |
Teixeira, Raphaela Farias |
dc.contributor.advisor1.fl_str_mv |
Medeiro, Andrea Monteiro Correia |
dc.contributor.advisor-co1.fl_str_mv |
Kassa, Samir Buainain |
contributor_str_mv |
Medeiro, Andrea Monteiro Correia Kassa, Samir Buainain |
dc.subject.por.fl_str_mv |
Desmame do respirador Extubação Recém-nascido de baixo peso Recém-nascido prematuro Respiração artificial Terapia intensiva neonatal |
topic |
Desmame do respirador Extubação Recém-nascido de baixo peso Recém-nascido prematuro Respiração artificial Terapia intensiva neonatal Ventilator weaning Extubation Infant low birth weight. Infant premature Respiration artificial Intensive care neonatal. CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
Ventilator weaning Extubation Infant low birth weight. Infant premature Respiration artificial Intensive care neonatal. |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE |
description |
Spontaneous Breathing Trials (SBT) have been used to evaluate extubation readiness in Neonatal Intensive Care Units (NICU), aiming to improve successful extubation rates in preterm infants. However, studies about SBT in the neonatal population are still scarce, especially regarding the ideal duration of the test. Thus, this thesis had two objectives: I) to systematically review the literature about the accuracy of SBT as a predictor for extubation failure in preterm infants; and II) to evaluate the effects of a 5-minutes SBT and a 10-minutes SBT on successful extubation rates of very low birth weight (VLBW) infants compared to clinical judgment alone. The proposed methods involved a systematic review of the literature with meta-analysis and a double-blind randomized controlled clinical trial (RCT). The systematic review included six studies for qualitative and quantitative analysis, which performed the SBT with 3 or 5 minutes, using the endotracheal continuous positive airway pressure (ET-CPAP) mode and positive end-expiratory pressure (PEEP) equivalent to conventional ventilation. In these studies, the SBT showed a high pooled sensitivity (0.97; 95% CI 0.85-0.99), demonstrating that most of the infants that had a successful extubation were correctly identified by an approved test, but a low pooled specificity (0.40, 95% CI 0.24–0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. In the RCT, 88 VLBW infants from two NICU of Alagoas were randomized into three groups: control group, 5-minutes SBT group and 10-minutes SBT group. SBT was performed under ET-CPAP mode with PEEP 5 cmH2O, inspiratory flow 10 L/min and FiO2 of 30%. Test failure was determined if the infant had, at any time during the test: bradycardia lasting longer than 15 seconds, and/or dessaturation for more than 15 seconds; and/or signs of respiratory distress with a Silverman Andersen Respiratory Severity Score higher than 5. The primary outcome was successful extubation rate, defined as no need for reintubation within 7 days after extubation. The results showed no difference among the three groups in relation to the proportion of successful extubation rate (p = 0.644), bronchopulmonary dysplasia occurrence (p = 0.790) and hospital length stay (p = 0.175). In general, both the systematic review and the RCT performed here do not support the use of SBT in premature infants as the main criterion in the final decision to extubate it. The passed test may be accompanied by many false positives, not correctly identifying the infants that could fail in the extubation, and adding little value to the clinical judgment. On the other hand, a failed test may be more useful in clinical practice, since the probability of having a successful extubation in failed test infants has decreased. This may serve as a warning to the clinical team, stimulating the infant´s reevaluation, identifying the possible causes of this failure and judging the cost-benefit of postponing extubation. |
publishDate |
2020 |
dc.date.issued.fl_str_mv |
2020 |
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2023-02-14T18:25:21Z |
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2023-02-14T18:25:21Z |
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info:eu-repo/semantics/doctoralThesis |
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dc.identifier.citation.fl_str_mv |
TEIXEIRA, Raphaela Farias. Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros. 2020. 81 f. Tese (doutorado em Ciências da Saúde) – Universidade Federal de Sergipe, Aracaju, 2020. |
dc.identifier.uri.fl_str_mv |
http://ri.ufs.br/jspui/handle/riufs/17130 |
identifier_str_mv |
TEIXEIRA, Raphaela Farias. Teste de respiração espontânea e avaliação da prontidão para extubação de recém-nascidos prematuros. 2020. 81 f. Tese (doutorado em Ciências da Saúde) – Universidade Federal de Sergipe, Aracaju, 2020. |
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Universidade Federal de Sergipe |
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