Fatores preditivos do sucesso de extubação em recém-nascidos prematuros: uma revisão sistemática

Abstract

Introduction: Currently, the decision to extubate preterm newborns depends mainly on clinical judgment, that is, on the experience of the health professional, on the interpretation of the general clinical stability of the baby and on the analyzes of several studies of isolated predictors, which consume time and many sometimes show inconsistent results. Objective: Evaluate the evidence on the predictors of extubation success in preterm neonates and to systematize their results for a better understanding and use of these predictors. Methods: We carried out an advanced search in the databases of scientific publications, PubMed®, PEDRO, Periodicals CAPES, Web of Science and Science Direct of articles in the english language, to assess predictors of extubation success in preterm infants. Filters were applied to select complete articles such as cross-sectional, prospective, retrospective studies carried out with human beings. The methodological quality through the QUADAS-2 method. Results: 150 studies were selected through the search engines, after applying the eligibility criteria, 128 studies were excluded, with 9 published studies being selected, between 2017 and 2022 were selected for full Reading. In relation to clinical and developmental predictors, higher gestational age, shorter duration of mechanical ventilation, prolonged rupture of the membrane >18h, Apgar>7, higher pH, lower FiO2 and pCO2 are predictors of success, as well as modified spontaneous breathing tests that were able to predict successful extubations with sensitivity above 80%. Conclusion: Thus, this unprecedented study showed different predictors related to extubation success, providing an interesting evidence analysis strategy to guide health professionals in the extubations of premature babies, thus reducing the variability of results and the risks of failure.