Spontaneous Breathing Trial with 5 and 10 minutes in Very Low Birth Weight Infants: randomized controlled trial

Authors

DOI:

https://doi.org/10.33448/rsd-v11i5.28338

Keywords:

Infant, Premature; Infant, Very Low Birth Weight; Airway Extubation; Respiration, Artificial; Ventilator Weaning; Intensive Care, Neonatal.

Abstract

This clinical trial aimed to evaluated 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. A double-blind randomized controlled trial was conducted in two NICU in Alagoas, Brazil, including 88 VLBW infants allocated in three groups: control group, 5-minutes SBT and 10-minutes SBT. SBT was performed under endotracheal CPAP mode with 5 cmH2O positive end-expiratory pressure, inspiratory flow 10 L/min and FiO2 of 30%. The primary outcome was successful extubation rate, defined as no need for reintubation within 7 days after extubation. There was no difference among the three groups in relation to the proportion of successful extubation rate (p =0.644), bronchopulmonary dysplasia (BPD) (p =0.790) and hospital length stay (p = 0.175). To have passed the 5-minutes or the 10-minutes SBT did not improve successful extubation rates in VLBW infants compared to clinical judgment alone or made difference in BDP occurrence and hospital stay length. Designing a predictor test of extubation readiness in preterm infants remains a challenging in respiratory management.

References

Al-Mandari, H., Shalish, W., Dempsey, E., Keszler, M., Davis, P. G., & Sant'Anna, G. (2015). International survey on periextubation practices in extremely preterm infants. Archives of disease in childhood. Fetal and neonatal edition, 100(5), F428–F431.

Al Mandhari, H., Finelli, M., Chen, S., Tomlinson, C., & Nonoyama, M. L. (2019). Effects of an extubation readiness test protocol at a tertiary care fully outborn neonatal intensive care unit. Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR, 55, 81–88.

Andrade, L. B., Melo, T. M., Morais, D. F., Lima, M. R., Albuquerque, E. C., & Martimiano, P. H. (2010). Spontaneous breathing trial evaluation in preterm newborns extubation. Avaliação do teste de respiração espontânea na extubação de neonatos pré-termo. Revista Brasileira de terapia intensiva, 22(2), 159–165.

Bacci, S.L.L.S., Johnston, C., Hattori, W.T., Pereira, J.M., & Azevedo, V.M.G.O. (2020). Práticas de desmame da ventilação mecânica nas UTIs pediátricas e neonatais brasileiras: Weaning Survey-Brazil. J Bras Pneumol, 46(4):e20190005.

Burns, K., Soliman, I., Adhikari, N., Zwein, A., Wong, J., Gomez-Builes, C., Pellegrini, J. A., Chen, L., Rittayamai, N., Sklar, M., Brochard, L. J., & Friedrich, J. O. (2017). Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis. Critical care (London, England), 21(1), 127.

Chawanpaiboon, S., Vogel, J. P., Moller, A. B., Lumbiganon, P., Petzold, M., Hogan, D. … Gülmezoglu, A. M. (2019). Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. The Lancet. Global health, 7(1), e37–e46.

Chawla, S., Natarajan, G., Gelmini, M., & Kazzi, S. N. (2013). Role of spontaneous breathing trial in predicting successful extubation in premature infants. Pediatric pulmonology, 48(5), 443–448.

Chawla, S., Natarajan, G., Shankaran, S., Carper, B., Brion, L. P., Keszler, M., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2017). Markers of Successful Extubation in Extremely Preterm Infants, and Morbidity After Failed Extubation. The Journal of pediatrics, 189, 113–119.e2.

Choi, Y. B., Lee, J., Park, J., & Jun, Y. H. (2018). Impact of Prolonged Mechanical Ventilation in Very Low Birth Weight Infants: Results From a National Cohort Study. The Journal of pediatrics, 194, 34–39.e3.

Dassios, T., Kaltsogianni, O., & Greenough, A. (2017). Relaxation Rate of the Respiratory Muscles and Prediction of Extubation Outcome in Prematurely Born Infants. Neonatology, 112(3), 251–257.

Fiatt, M., Bosio, A. C., Neves, D., Symanski da Cunha, R., Fonseca, L. T., & Celeste, R. K. (2021). Accuracy of a spontaneous breathing trial for extubation of neonates. Journal of neonatal-perinatal medicine, 14(3), 375–382.

Giaccone, A., Jensen, E., Davis, P., & Schmidt, B. (2014). Definitions of extubation success in very premature infants: a systematic review. Archives of disease in childhood. Fetal and neonatal edition, 99(2), F124–F127.

Janjindamai, W., Pasee, S., & Thatrimontrichai, A. (2017). The Optimal Predictors of Readiness for Extubation in Low Birth Weight Infants. Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 100(4), 427–434.

Jobe, A. H., & Bancalari, E. (2001). Bronchopulmonary dysplasia. American journal of respiratory and critical care medicine, 163(7), 1723–1729.

Hedstrom, A. B., Gove, N. E., Mayock, D. E., & Batra, M. (2018). Performance of the Silverman Andersen Respiratory Severity Score in predicting PCO2 and respiratory support in newborns: a prospective cohort study. Journal of perinatology : official journal of the California Perinatal Association, 38(5), 505–511.

Hermeto, F., Martins, B. M., Ramos, J. R., Bhering, C. A., & Sant'Anna, G. M. (2009). Incidence and main risk factors associated with extubation failure in newborns with birth weight < 1,250 grams. Jornal de pediatria, 85(5), 397–402.

Kaczmarek, J., Kamlin, C. O., Morley, C. J., Davis, P. G., & Sant'anna, G. M. (2013). Variability of respiratory parameters and extubation readiness in ventilated neonates. Archives of disease in childhood. Fetal and neonatal edition, 98(1), F70–F73.

Kamlin, C. O., Davis, P. G., & Morley, C. J. (2006). Predicting successful extubation of very low birthweight infants. Archives of disease in childhood. Fetal and neonatal edition, 91(3), F180–F183.

Konduri, G. G., Lagatta, J., Lakshminrusimha, S., & Saugstad, O. D. (2019). Finally, A Tool to Address Extubation Anxiety!. Journal of perinatology : official journal of the California Perinatal Association, 39(12), 1581–1583.

Maia, L., Souza, W. V., & Mendes, A. (2020). Determinantes individuais e contextuais associados à mortalidade infantil nas capitais brasileiras: uma abordagem multinível [Individual and contextual determinants of infant mortality in Brazilian state capitals: a multilevel approach]. Cadernos de saude publica, 36(2), e00057519.

Manley, B. J., Doyle, L. W., Owen, L. S., & Davis, P. G. (2016). Extubating Extremely Preterm Infants: Predictors of Success and Outcomes following Failure. The Journal of pediatrics, 173, 45–49.

Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gøtzsche, P. C., Devereaux, P. J., Elbourne, D., Egger, M., & Altman, D. G. (2010). CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ (Clinical research ed.), 340, c869.

Nakato, A. M., Ribeiro, D. F., Simão, A. C., Da Silva, R. P., & Nohama, P. (2021). Impact of Spontaneous Breathing Trials in Cardiorespiratory Stability of Preterm Infants. Respiratory care, 66(2), 286–291.

Ouellette, D. R., Patel, S., Girard, T. D., Morris, P. E., Schmidt, G. A., Truwit, J. D., Alhazzani, W., Burns, S. M., Epstein, S. K., Esteban, A., Fan, E., Ferrer, M., Fraser, G. L., Gong, M. N., Hough, C. L., Mehta, S., Nanchal, R., Pawlik, A. J., Schweickert, W. D., Sessler, C. N., … Kress, J. P. (2017). Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately After Extubation. Chest, 151(1), 166–180.

Robbins M, Trittmann J, Martin E, Reber KM, Nelin L, Shepherd E. Early extubation attempts reduce length of stay in extremely preterm infants even if re-intubation is necessary. J Neonatal Perinatal Med. 2015;8(2):91-7.

Shalish, W., Sant’ Anna, G.M., Natarajan, G. & Chawla, S. (2014). When and How to Extubate Premature Infants from Mechanical Ventilation. Curr Pediatr Rep.,2, 18–25.

Shalish, W., Kanbar, L., Keszler, M., Chawla, S., Kovacs, L., Rao, S., Panaitescu, B. A., Laliberte, A., Precup, D., Brown, K., Kearney, R. E., & Sant'Anna, G. M. (2018). Patterns of reintubation in extremely preterm infants: a longitudinal cohort study. Pediatric research, 83(5), 969–975.

Shalish, W., Kanbar, L., Kovacs, L., Chawla, S., Keszler, M., Rao, S., Panaitescu, B., Laliberte, A., Precup, D., Brown, K., Kearney, R. E., & Sant'Anna, G. M. (2019a). The Impact of Time Interval between Extubation and Reintubation on Death or Bronchopulmonary Dysplasia in Extremely Preterm Infants. The Journal of pediatrics, 205, 70–76.e2.

Shalish, W., Latremouille, S., Papenburg, J., & Sant'Anna, G. M. (2019b). Predictors of extubation readiness in preterm infants: a systematic review and meta-analysis. Archives of disease in childhood. Fetal and neonatal edition, 104(1), F89–F97.

Shalish, W., Kanbar, L., Kovacs, L., Chawla, S., Keszler, M., Rao, S., Latremouille, S., Precup, D., Brown, K., Kearney, R. E., & Sant'Anna, G. M. (2020). Assessment of Extubation Readiness Using Spontaneous Breathing Trials in Extremely Preterm Neonates. JAMA pediatrics, 174(2), 178–185.

Stoll, B. J., Hansen, N. I., Bell, E. F., Walsh, M. C., Carlo, W. A., Shankaran, S., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2015). Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012. JAMA, 314(10), 1039–1051.

Teixeira, R. F., Carvalho, A., de Araujo, R. D., Veloso, F., Kassar, S. B., & Medeiros, A. (2021). Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis. Respiratory care, 66(1), 129–137.

Veloso, F., Kassar, L., Oliveira, M., Lima, T., Bueno, N. B., Gurgel, R. Q., & Kassar, S. B. (2019). Analysis of neonatal mortality risk factors in Brazil: a systematic review and meta-analysis of observational studies. Jornal de pediatria, 95(5), 519–530.

Vervenioti, A., Dassios, T., Sinopidis, X., & Dimitriou, G. (2021). Does a brief trial of endotracheal CPAP before extubation increase the work of breathing in preterm infants?. Early human development, 157, 105368.

Walsh, M. C., Morris, B. H., Wrage, L. A., Vohr, B. R., Poole, W. K., Tyson, J. E., ... National Institutes of Child Health and Human Development Neonatal Research Network (2005). Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes. The Journal of pediatrics, 146(6), 798–804.

Published

10/04/2022

How to Cite

TEIXEIRA, R. F.; COSTA, C. M. X. .; RODRIGUES, R. C. A.; SILVA, M. de J. S.; CALHEIROS, A. K. . de M.; SANTOS, V. S. .; KASSAR, S. B. .; GURGEL, R. Q. .; MEDEIROS, A. M. C. Spontaneous Breathing Trial with 5 and 10 minutes in Very Low Birth Weight Infants: randomized controlled trial. Research, Society and Development, [S. l.], v. 11, n. 5, p. e39011528338, 2022. DOI: 10.33448/rsd-v11i5.28338. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/28338. Acesso em: 24 nov. 2024.

Issue

Section

Health Sciences