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Intubation-Surfactant-Extubation Strategy in a Medical Resource-limited Department: A Prospective Study

Year: 2016

Type: article

Abstract: Benefits of the intubation, surfactant and extubation (INSURE) strategy are well established in the treatment of respiratory distress syndrome (RDS). However, it can be unsuccessful [ 1 , 2 ]. Nasal continuous positive airway pressure is the only form of ventilatory support at our institution. The aim of this study was to determine risk factors of the failure of INSURE strategy. We conducted a prospective analysis from January 2012 to December 2013. Inclusion criteria were gestational age (GA) between 27 and 35 weeks, including clinical and radiologic findings of RDS. RDS Grades 3 and 4 on the initial chest X-ray were considered as severe [ 3 ]. Porcine surfactant was administered (100–200 mg/kg) if FiO2 was >35% to maintain oxygen saturation between 88 and 92%. INSURE failure was defined as the need for re-intubation within 72 h after INSURE (FiO2 >45% and progressive respiratory failure). Data were analyzed using the SPSS version 18. The differences were considered as significant for p value <0.05. We performed a model of logistic regression to control for the effect of potential confounding variables. Forty infants were studied. Their characteristics are presented in Table 1 . INSURE failure was registered in 13 infants (32.5%). Characteristics of neonates Note . IQR: interquartile ratio. Characteristics of neonates Note . IQR: interquartile ratio. Table 2 shows the variables that were statistically different between INSURE failure and INSURE success groups in univariate analyses. After controlling for confounding variables, only FiO2 before surfactant therapy [ p = 0.046; adjusted odds ratio (OR) = 7.9; 95% confidence interval (CI) for adjusted OR = 1.07–60] and severe RDS on the initial chest X-ray ( p = 0.009; adjusted OR = 1.063; 95% CI for adjusted OR = 1.01–1.011) were associated with a significant increased risk of failure of the INSURE method. Variables statistically different between INSURE groups in univariate comparative analyses Variables statistically different between INSURE groups in univariate comparative analyses Our study showed that INSURE failed in 32.5% of cases, and the main factors of failure were high FiO2 before surfactant therapy and severe RDS on the initial chest X-ray.

Source: Journal of Tropical Pediatrics

DOI: 10.1093/tropej/fmv074