Eventos adversos relacionados à terapia ventilatória em recém-nascidos de alto risco

Abstract

The objective was to analyze the adverse events related to respiratory therapy in high-risk newborns of a neonatal unit. It is an observational, longitudinal and prospective study, performed in a maternity unit, a reference unit in the State of Rio Grande do Norte for high-risk pregnancy and birth. The data were collected from April to September 2016, after approval of the project in the Research Ethics Committee of UFRN with CAAE nº 51832415.0.0000.5537. The sample consisted of 82 newborns submitted to ventilatory therapy in the modalities: invasive mechanical ventilation, non-invasive mechanical ventilation and continuous positive airway pressure per prong nasal. Results show that the incidence of adverse events was 48.8%, most frequently unplanned extubation (34%), followed by nasal septum injury (13%), ventilator-associated pneumonia (7%), and Or pneumothorax (6%). The probability of an adverse event occurring in a neonate undergoing ventilatory therapy in the first five days of therapy exceeded 40% (95% CI). There is an association between gestational age and the occurrence of adverse events, with newborn infants less than 28 weeks being the most susceptible (p-value 0.024). The odds ratio for a newborn suffering an adverse event in gestational extreme is 5.57 times greater than one full-term, 95% CI [1.44, 21.60]. There was an association between the non-invasive mechanical ventilation and the occurrence of nasal septum lesion (p-value <0.001). On the contrary, there was no association between the occurrence of the same event and the nasal CPAP modality (p-value 0.160). The results of the logistic regression show an association between the congenital malformation and the occurrence of the general adverse event (p-value 0.003) and by type specifically the unplanned extubation (p-value 0.039). Therefore it is concluded that premature newborns with congenital malformations are susceptible to the occurrence of these adverse events. And as an opportunity to improve care, it is recommended the construction and validation of protocols for prevention of unplanned extubation, which meets the specificities of patients with congenital malformations, in addition to the minimum protocol for the management of extremely premature infants.