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Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score

The factors influencing weaning of preterm infants from noninvasive ventilation (NIV) are poorly defined and the weaning decisions are often driven by subjective judgement rather than objective measures. To standardize quantification of respiratory effort, the Silverman-Andersen Score (SAS) was incl...

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Autores principales: Nussbaum, Claudia, Lengauer, Maximilian, Puchwein-Schwepcke, Alexandra F., Weiss, Veronique B. N., Spielberger, Benedikt, Genzel-Boroviczény, Orsolya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9497739/
https://www.ncbi.nlm.nih.gov/pubmed/36138599
http://dx.doi.org/10.3390/children9091292
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author Nussbaum, Claudia
Lengauer, Maximilian
Puchwein-Schwepcke, Alexandra F.
Weiss, Veronique B. N.
Spielberger, Benedikt
Genzel-Boroviczény, Orsolya
author_facet Nussbaum, Claudia
Lengauer, Maximilian
Puchwein-Schwepcke, Alexandra F.
Weiss, Veronique B. N.
Spielberger, Benedikt
Genzel-Boroviczény, Orsolya
author_sort Nussbaum, Claudia
collection PubMed
description The factors influencing weaning of preterm infants from noninvasive ventilation (NIV) are poorly defined and the weaning decisions are often driven by subjective judgement rather than objective measures. To standardize quantification of respiratory effort, the Silverman-Andersen Score (SAS) was included in our nursing routine. We investigated the factors that steer the weaning process and whether the inclusion of the SAS would lead to more stringent weaning. Following SAS implementation, we prospectively evaluated 33 neonates born ≤ 32 + 0 weeks gestational age. Age-, weight- and sex-matched infants born before routine SAS evaluation served as historic control. In 173 of 575 patient days, NIV was not weaned despite little respiratory distress (SAS ≤ 2), mainly due to bradycardias (60% of days without weaning), occurring alone (40%) or in combination with other factors such as apnea/desaturations. In addition, “soft factors” that are harder to grasp impact on weaning decisions, whereas the SAS overall played a minor role. Consequently, ventilation times did not differ between the groups. In conclusion, NIV weaning is influenced by various factors that override the absence of respiratory distress limiting the predictive value of the SAS. An awareness of the factors that influence weaning decisions is important as prolonged use of NIV has been associated with adverse outcome. Guidelines are necessary to standardize NIV weaning practice.
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spelling pubmed-94977392022-09-23 Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score Nussbaum, Claudia Lengauer, Maximilian Puchwein-Schwepcke, Alexandra F. Weiss, Veronique B. N. Spielberger, Benedikt Genzel-Boroviczény, Orsolya Children (Basel) Article The factors influencing weaning of preterm infants from noninvasive ventilation (NIV) are poorly defined and the weaning decisions are often driven by subjective judgement rather than objective measures. To standardize quantification of respiratory effort, the Silverman-Andersen Score (SAS) was included in our nursing routine. We investigated the factors that steer the weaning process and whether the inclusion of the SAS would lead to more stringent weaning. Following SAS implementation, we prospectively evaluated 33 neonates born ≤ 32 + 0 weeks gestational age. Age-, weight- and sex-matched infants born before routine SAS evaluation served as historic control. In 173 of 575 patient days, NIV was not weaned despite little respiratory distress (SAS ≤ 2), mainly due to bradycardias (60% of days without weaning), occurring alone (40%) or in combination with other factors such as apnea/desaturations. In addition, “soft factors” that are harder to grasp impact on weaning decisions, whereas the SAS overall played a minor role. Consequently, ventilation times did not differ between the groups. In conclusion, NIV weaning is influenced by various factors that override the absence of respiratory distress limiting the predictive value of the SAS. An awareness of the factors that influence weaning decisions is important as prolonged use of NIV has been associated with adverse outcome. Guidelines are necessary to standardize NIV weaning practice. MDPI 2022-08-26 /pmc/articles/PMC9497739/ /pubmed/36138599 http://dx.doi.org/10.3390/children9091292 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nussbaum, Claudia
Lengauer, Maximilian
Puchwein-Schwepcke, Alexandra F.
Weiss, Veronique B. N.
Spielberger, Benedikt
Genzel-Boroviczény, Orsolya
Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score
title Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score
title_full Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score
title_fullStr Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score
title_full_unstemmed Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score
title_short Noninvasive Ventilation in Preterm Infants: Factors Influencing Weaning Decisions and the Role of the Silverman-Andersen Score
title_sort noninvasive ventilation in preterm infants: factors influencing weaning decisions and the role of the silverman-andersen score
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9497739/
https://www.ncbi.nlm.nih.gov/pubmed/36138599
http://dx.doi.org/10.3390/children9091292
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