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Vitti JD, de Castro AAM, Serrão NF. Use of noninvasive mechanical ventilation weaning protocol in neonatal intensive care units in Brazil: a descriptive study. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021382. [PMID: 37194837 PMCID: PMC10184999 DOI: 10.1590/1984-0462/2023/41/2021382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/13/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study aimed to investigate whether neonatal intensive care units (NICUs) in Brazilian hospitals use a protocol for weaning from noninvasive ventilation (NIV), how this ventilatory support is withdrawn, and whether there is consensus among the methods used by the institutions. METHODS A cross-sectional survey was conducted from December 2020 to February 2021, based on responses to an electronic questionnaire, filled out by physical therapists working in NICU in Brazilian hospitals about the routine of physical therapy and the use of NIV and its weaning. RESULTS A total of 93 answers to the electronic questionnaire met the study criteria: 52.7% were from public health institutions, with an average of 15 NICU beds (15.2±15.9), 85% of the physical therapists worked exclusively in the NICU, 34.4% of the NICU had 24-h physical therapy care, 66.7% of the units use the continuous positive airway pressure (CPAP) as ventilatory mode, and 72% the nasal prong as NIV interface; 90% of the NICU physical therapists answered that their NICU had no NIV weaning protocol, with various methods of weaning reported, the most cited being pressure weaning. CONCLUSIONS Most Brazilian NICUs have no NIV weaning protocol. The most used method among institutions, with or without a protocol, is pressure weaning. Although most of the participating physical therapists work exclusively in NICU, many hospitals do not have the recommended workload, which can be one of the negative factors in the organization of protocols and in the progress of ventilatory weaning.
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Mohsen N, Nasef N, Elkhouli M, Ghanem M, Dalby A, Yoon EW, Finan E, Shah PS, Mohamed A. Predictors of successful trial off continuous positive airway pressure and high flow nasal cannula in preterm infants <30 weeks' gestation: A retrospective study. Pediatr Pulmonol 2022; 57:1000-1007. [PMID: 35032109 DOI: 10.1002/ppul.25827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/18/2021] [Accepted: 01/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To identify the predictors of successful first trial off nasal continuous positive airway pressure (nCPAP). METHODS A retrospective cohort study of infants ≤29 weeks' gestation who required nCPAP for >24 h was conducted. Logistic regression was used to detect predictors for successful trial off nCPAP. Statistical analysis was performed using the SAS software. RESULTS A total of 727 infants were included in the analysis. Infants who were successful in their first trial off nCPAP (n = 313) were of higher gestational age (GA) and birth weight (BW), as well as a higher proportion of female infants, compared with those who were not successful (p < 0.01). When stratified by GA, a negative correlation was noted between GA and postmenstrual age at successful trial off nCPAP or high flow nasal cannula (HFNC) (r = 0.45, p < 0.01). Logistic regression analysis showed that GA (odds ratio [OR] 1.13, 95% confidence interval [CI] [1.03-1.24], p = 0.01) and percentage of time spent with an oxygen saturation over 89% in the 24 h preceding the trial off nCPAP (OR 1.08, 95% CI [1.05-1.11], p = 0.00) were independent predictors for successful trial off nCPAP. CONCLUSION Successful trial off nCPAP or HFNC in preterm infants is significantly associated with higher GA, BW, female gender, and the specific oxygen saturation histogram in the preceding 24-h period.
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Affiliation(s)
- Nada Mohsen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Mansoura University, Mansoura, Egypt
| | - Mohamed Elkhouli
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Mohab Ghanem
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Allison Dalby
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Eugene Woojin Yoon
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Emer Finan
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation (HPME), University of Toronto, Toronto, Ontario, Canada
| | - Adel Mohamed
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
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Fernandez-Alvarez JR, Mahoney L, Gandhi R, Rabe H. Optiflow vs Vapotherm as extended weaning mode from nasal continuous positive airway pressure in preterm infants ≤ 28 weeks gestational age. Pediatr Pulmonol 2020; 55:2624-2629. [PMID: 32609425 DOI: 10.1002/ppul.24936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/15/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Current evidence supports nasal continuous positive airway pressure (NCPAP) weaning. Heated humidified high-flow nasal cannula (HHFNC) reduces NCPAP time in infants less than 28 weeks gestational age (GA) without increasing morbidity. The aim of the study was to compare the two most frequently used HHFNC devices in weaning from NCPAP. METHODOLOGY We performed a retrospective matched-pair case-control study of infants less than or equal to 28 GA born in a single tertiary neonatal center managed with Optiflow or Vapotherm after being weaned from NCPAP. Patients were matched for antenatal steroid doses, delivery mode, birth plurality, GA, birthweight, gender, surfactant doses, length of mechanical ventilation, and length of NCPAP. Outcome measures were duration of HHFNC, low-flow nasal cannula, nasal bridge lesions, pneumothorax, bronchopulmonary dysplasia, postnatal steroids, necrotizing enterocolitis, sepsis, intraventricular hemorrhage, retinopathy of prematurity, length of stay, discharge weight, and mortality. Results were displayed as median (interquartile range) or ratio (percentage). Statistical analysis was performed using Mann-Whitney U and χ2 tests. RESULTS 70 patients were recruited retrospectively. Thirty-five infants were weaned from NCPAP to Optiflow and 35 infants to Vapotherm with gestational ages and birthweights of 27 GA (26-27) and 1010 g (835-1165) and 27 GA (26-28) and 960 g (788-1191), respectively. There was no statistically significant difference in any outcome measure. Infants managed with Vapotherm required a not statistically significant shorter length of time on HHFNC and low-flow nasal cannula. CONCLUSIONS Optiflow and Vapotherm seem to be equally effective and safe for weaning from NCPAP. However, infants weaned to Vapotherm appear to spend less time on non-invasive respiratory support.
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Affiliation(s)
- J Ramon Fernandez-Alvarez
- Department of Neonatology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals Trust, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
| | - Liam Mahoney
- Department of Neonatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rashmi Gandhi
- King's College Hospital NHS Foundation Trust, London, UK
| | - Heike Rabe
- Department of Neonatology, Royal Sussex County Hospital, Brighton and Sussex University Hospitals Trust, Brighton, UK.,Brighton and Sussex Medical School, Brighton, UK
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