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Predictive monitoring for respiratory decompensation leading to urgent unplanned intubation in the neonatal intensive care unit.
MedLine Citation:
PMID:  23138402     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BackgroundInfants admitted to the neonatal intensive care unit (NICU), and especially those born with very low birth weight (VLBW; <1500 grams), are at risk for respiratory decompensation requiring endotracheal intubation and mechanical ventilation. Intubation and mechanical ventilation are associated with increased morbidity, particularly in urgent unplanned cases.MethodsWe tested the hypothesis that the systemic response associated with respiratory decompensation can be detected from physiological monitoring, and that statistical models of bedside monitoring data can identify infants at increased risk of urgent, unplanned intubation. We studied 287 VLBW infants consecutively admitted to our NICU and found 96 events in 51 patients, excluding intubations occurring within 12 hours of a previous extubation.ResultsIn order of importance in a multivariable statistical model, we found the characteristics of reduced O(2) saturation, especially as heart rate was falling, increased heart rate correlation with respiratory rate, and the amount of apnea all were significant independent predictors. The predictive model, validated internally by bootstrap, had receiver-operating characteristic area of 0.84 + 0.04.ConclusionsWe propose that predictive monitoring in the NICU for urgent unplanned intubation may improve outcomes by allowing clinicians to intervene non-invasively before intubation is required.Pediatric Research (2012); doi:10.1038/pr.2012.155.
Authors:
Matthew T Clark; Brooke D Vergales; Alix O Paget-Brown; Terri J Smoot; Douglas E Lake; John L Hudson; John B Delos; John Kattwinkel; J Randall Moorman
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-08
Journal Detail:
Title:  Pediatric research     Volume:  -     ISSN:  1530-0447     ISO Abbreviation:  Pediatr. Res.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0100714     Medline TA:  Pediatr Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Chemical Engineering, University of Virginia, Charlottesville, VA 22904.
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