Weaning from mechanical ventilation of newborn children after multiple organ failuer

Abstract

In order to study the process of weaning from mechanical ventilation, we examined 200 newborns who were on mechanical ventilation in the ICU. The prospective period amounted to one year after birth. Multiple organ failure (MOF) was detected in 165 newborns (82,5%), of which died, before they reached the age of 48 (29%), 35 patients (17,5%) were without MOF, all survived to a year. Thus, the entire cohort of patients was divided into three groups: group 1 - the group of newborns without MOF (35 patients), group 2 - the group of surviving newborns with MOF (117 patients), group 3 - the group of deceased newborns with MOF (48 patients). The results of the study showed that the frequency of prolonged weaning from mechanical ventilation was significantly higher in the groups of children with MOF (60,7% in the group who survived to one year and 83% in the group of deceased), compared with the group of children without MOF (31%), p<0, 0001 (Chi-square method). The frequency of ineffective weaning and reintubations in the group of deceased children with MOF is also statistically significantly higher than in the group of surviving children with MOF, while between groups of children of surviving children with MOF and without MOF, there are no statistically significant results. The duration of mechanical ventilation was also significantly higher in the group of surviving children with MOF, whereas between the groups of deceased and surviving newborns with MOF, there were no statistically significant differences. Thus, the use of the “aggressive” method of weaning in newborns with MOF is unacceptable, as it is associated with an increased frequency of reintubations, ineffective and prolonged weaning, which increases the risk of death. When weaning a newborn with MOF from the ventilator, it is necessary to use a specially developed protocol that takes into account the individual characteristics of the patient.