Desmame de CPAP em neonatos pré-termo: uma revisão integrativa

Abstract

Introduction: The main causes of high neonatal mortality include complications of prematurity and lower respiratory tract infections. The effects and indications or contraindications of the use of Continuous Positive Airway Pressure (CPAP) are widely discussed in the literature, however the best strategy for weaning from this modality is not yet well established. Objectives: Review studies on the CPAP weaning process in preterm neonates, as well as analyze such weaning strategies and describe the results presented. In the end, develop a suggested CPAP weaning checklist for the Neonatal Intensive Care Unit at the Santa Maria University Hospital. Methodology: The present study was characterized as an integrative review. A search was carried out in the MEDLINE databases via PubMed, ScienceDirect and the Cochrane Library, for studies published between 2014 and 2023, in Portuguese, English and/or Spanish. The studies should contain at least one group of preterm neonates in which previously defined criteria were used for weaning from CPAP, and a group in which different criteria were used for weaning from CPAP and/or a control group. Exclusion criteria were also established and an electronic form was developed for data extraction. Results: After the study selection process, eight articles were officially included. These were published between 2015 and 2022, and were carried out in Intensive Care Units (ICUs) in the United States, Canada, Denmark, Australia, Thailand, China and New Zealand. The samples were mainly composed of neonates born with <30 weeks of gestational age and three studies included neonates with <1,000g at birth. Corrected gestational age and weight at weaning varied between 28 and 38 weeks and between 662g and 2,310g. As results of this study, weaning success rates in the first attempt, corrected gestational age at successful weaning, bronchopulmonary dysplasia rate and length of hospital stay were collected. Only three articles presented all the data of interest. Final considerations: The heterogeneity of studies does not allow us to infer which strategy is superior to the others. From this, a CPAP weaning checklist was developed to be implemented in the Neonatal Intensive Care Unit of the Santa Maria University Hospital, with the aim of collecting data about the profile of the public served, the criteria and strategies used in the weaning process. and its outcomes. It is hoped that in the future the data collected will serve as guidelines for a cohesive and efficient weaning process.