Indicadores clínicos de extubação não planejada em uma Unidade de Terapia Intensiva Neonatal

Abstract

Objective: To verify the prevalence, main circumstances associated with unplanned extubation (ENP), as well as its clinical outcomes in newborns admitted to the Neonatal Intensive Care Unit of the Hospital de Clínicas of the Federal University of Uberlândia (HC-UFU/Ebserh). Methods: This is a retrospective cross-sectional study, carried out from January 1, 2018 to December 31, 2019. Data were collected using a structured form routinely used by the team and subsequently added and organized in a Microsoft Office Excel 2016 spreadsheet. Statistical analysis was performed using the SPSS version 22 program for Windows and the data presented in tables, figures and flowchart. Results: There were 40 cases of unplanned extubation, with an incidence of 1.11 ENP/100 days of intubation. The profile of newborns that most presented unplanned extubation were premature infants < 28 weeks and weighing < 1000gr. The causes (handling of the baby, psychomotor agitation, loose fixation and inadequate positioning of the TEC) of unplanned extubation that stood out the most were psychomotor agitation (54.5%) and handling (24.2%), with the majority of these were without sedation (86.8%). The shift that had the highest occurrence was the night shift (47.5%), but it did not present a significant difference in relation to the other shifts (p 0.103). Conclusion: The present study showed an unplanned extubation rate (1.11), comparable to the findings in the literature. Our work showed significant occurrences related to ENP in preterm infants weighing < 1000 grams, male, with a GA of less than 28 weeks in the absence of continuous sedation, with MV time greater than 7 days, having as main cause the main psychomotor agitation The outcome of these patients was reintubation within 72 hours, even in those who used NIV or CPAP. It reinforces the need for preventive actions through training of the multidisciplinary team and more appropriate management of these patients, seen as more vulnerable to adverse events, based on the results shown.