| BackgroundThe various organ systems of premature infants are immature,and normal spontaneous breathing cannot be established due to various reasons.Invasive mechanical ventilation is a common life support technology used to maintain breathing in critically ill premature infants,but long-term mechanical ventilation will increase a variety of complications.Risks such as ventilator-associated pneumonia,pneumothorax,and bronchopulmonary dysplasia（BPD）seriously affect the prognosis of premature infants.Therefore,early weaning and reduction of mechanical ventilation time have become the most important factors in the respiratory management of premature infants after birth.Target.Spontaneous breathing test（SBT）refers to the use of tracheal intubation and low-level support for children receiving invasive mechanical ventilation through a short-term dynamic observation（3min-2h） to evaluate their spontaneous breathing.Ability.Some foreign studies have reported that the SBT test can be used as an evaluation index before weaning.However,some children who have passed the SBT test are still unable to be successfully weaned from the machine.Therefore,the successful weaning is still an important part of the respiratory management of premature infants.big challenge.Some studies have pointed out that due to the natural anatomical connection between the heart and the lungs,in the case that the respiratory system is basically stable,hemodynamic factors may be one of the reasons for the failure of weaning.Machine outcomes deserve clinical attention.Pulse perfusion index（Perfusion index,PI）is a parameter reflecting the hemodynamic state,which can non-invasively and dynamically monitor hemodynamic changes.In recent years,there have been many studies on the prediction of the severity of neonatal disease and the prognosis of premature infants by the PI value,while there are few studies on the correlation between the PI value and the outcome of weaning.ObjectiveTo analyze the high-risk factors of weaning failure in premature infants after mechanical ventilation,to explore the possible relationship between PI and the outcome of weaning,to clarify the predictive value of PI and SBT on the outcome of weaning of premature infants with mechanical ventilation Management provides clinical evidence.MethodsA prospective study was conducted on 106 premature infants who needed mechanical ventilation support within 24 hours after birth and who were admitted to the NICU of Xinxiang Central Hospital from January 2019 to December 2021.The clinical data of preterm infants,including basic information,perinatal data,treatment before and after weaning,non-invasive ventilator mode after weaning,prognosis of preterm infants,SBT test results,etc.were collected,and Masimo Radical-7（USA）was used.Pulse oximeter monitors the PI value of all premature infants,and records the PI value at 1h,6h,12 h,24h,at the beginning of SBT,and at the end of SBT after mechanical ventilation.A total of 6groups of PI values were obtained.Grouping method: The preterm infants included in the study were divided into the weaning success group and the weaning failure group according to the weaning outcome within 48 hours after weaning.Receiver operating curve（ROC）was used to analyze the predictive value of PI on weaning outcomes in preterm infants.This study was approved by the Ethics Committee of our hospital（approval number: 2019-047）,and the families of the patients gave informed consent.Inclusion criteria（1）Gestational age <37 weeks;（2）Admission within 1 hour after birth;（3）Need for invasive mechanical ventilation support within 24 hours after birth;（4）Invasive mechanical ventilation time > 24 hours;（5）Clinical data Complete,family informed consent.（2）Exclusion criteria（1）Gestational age ≥ 37 weeks;（2）Abandonment of treatment or death during mechanical ventilation;（3）Complex congenital heart disease;（4）Genetic metabolic disease and chromosomal abnormality;（5）Severe congenital malformation;（6）Incomplete clinical data;Results1.Comparative analysis of clinical data between the successful weaning group and the failed weaning group: the mean gestational age of the successful weaning group was 30.05±2.23 weeks,the birth weight was 1.25±0.36 kg,and the mean gestational age of the weaning failure group was 28.78±1.74 weeks,and the birth weight was 1.04±1.04±0.24 kg,the gestational age and birth weight of the successful weaning group were greater than those of the weaning failure group,and the difference was statistically significant（P<0.05）.Failure group,and the difference was statistically significant（P<0.05）.2.Comparative analysis of PI values 1h,6h,12 h,and 24 h after invasive mechanical ventilation in the weaning success group and the weaning failure group: The PI values in the weaning successful group at 1h,6h,12 h,and 24 h after mechanical ventilation were higher than those in the weaning failure group.group,and the difference was statistically significant（P<0.05）.3.Comparative analysis of the PI values at the beginning and end of the SBT test between the successful weaning group and the weaning failure group: the PI values at the beginning and the end of the SBT test in the successful weaning group were higher than those in the weaning failure group,and the difference was statistically significant（P <0.05）.4.The results of the SBT test in the weaning success group and the weaning failure group are analyzed as follows: Among the 97 premature infants included in the study,87 premature infants passed the SBT test,with a percentage of 89.7%,and 75 premature infants who passed the SBT test were weaned.Success,the positive predictive rate of SBT test for predicting the success of weaning was 86.2%（75/87）.5.The results of comparative analysis of related factors after weaning between the successful weaning group and the weaning failure group are as follows: There was no significant difference in the non-invasive assisted ventilation mode and nebulization after weaning between the successful weaning group and the weaning failure group（P> 0.05）.6.The comparative analysis of the prognosis of premature infants in the successful weaning group and the weaning failure group showed that the incidences of BPD,ROP and pulmonary hemorrhage in the successful weaning group were significantly lower than those in the failed weaning group,and the difference was statistically significant（all P<0.05）.,the hospital stay and oxygen inhalation time in the successful weaning group were shorter than those in the failure group,and the difference was statistically significant（all P<0.05）;the incidences of pneumonia,sepsis,and purulent meningitis in the successful weaning group were lower than those in the failed weaning group,but the difference was not statistically significant（all P>0.05）.7.The PI value after mechanical ventilation and the PI value during SBT were used to predict the weaning outcome of premature infants,and the ROC curve was constructed.The sensitivity,specificity and area under the curve（AUC）for predicting the success of weaning under this cut-off value were as follows:（1）The sensitivity of the PI value 1 h after mechanical ventilation to predict the success of weaning was 57.3%,the specificity was 77.3%,and the AUC was 0.678;（2）the PI value at 6 h after mechanical ventilation had a sensitivity of 48.0%,the specificity was 81.8%,and the AUC was 0.636 in predicting the success of weaning;（3）the PI value at 12 h after mechanical ventilation predicted the weaning success.The sensitivity of successful weaning was 82.0%,the specificity was36.4%,and the AUC was 0.624;（4）The PI value at 24 hours after mechanical ventilation had a sensitivity of 22.7%,a specificity of 77.3%,and an AUC of 0.647 to predict the success of weaning;（5）SBT started The PI value at the end of SBT had a sensitivity of36.0%,a specificity of 87.3%,and an AUC of 0.636 to predict the success of weaning;0.946.Conclusion1.Small gestational age,low birth weight,intubation in the delivery room,PDA,and mechanical ventilation time are high risk factors for premature infants’ weaning failure.2.The PI value is related to the failure of weaning of premature infants,and the PI value >1.05 at the end of the spontaneous breathing test can be used as a predictor of the success of weaning from invasive mechanical ventilation. |
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