Predictors of extubation outcomes among extremely and very preterm infants: a retrospective cohort study

He, Fang; Wu, Dihua; Sun, Yi; Lin, Yan; Wen, Xiulan; Cheng, Andy S. K.

doi:10.1016/j.jped.2022.04.001

Cited by 10 publications

(7 citation statements)

References 30 publications

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“…The development of the brain is critical for the control and regulation of breathing, and a study by Williams et al [ 38 ] showed that higher age at extubation was strongly associated with extubation success (ES) due to a more mature brain. This contradicts the findings of Dimitriou et al [ 27 ] and He et al [ 43 ], who suggested that prolonged ventilation before extubation causes disuse atrophy of the diaphragm, resulting in subsequent EF. Moreover, male infants are more susceptible to EF than female infants [ 39 ], and the incidence of meta integration is higher.…”

Section: Discussioncontrasting

confidence: 75%

“…Currently, the decision to extubate relies on clinical judgment through the interpretation of ventilatory support, blood gas values, and overall clinical stability of the neonate [ 37 ]. Pre-extubation pH, pre-extubation FiO 2 , pre-extubation PCO 2 , and MAP are important markers of extubation readiness and significant predictors of EF [ 16 , 17 , 19 , 31 , 39 , 41 – 43 , 49 ]. A lower pH indicates that the oxygen exchange capacity of the lungs is not meeting the body's demand for oxygen supply.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of extubation failure in newborns: a systematic review and meta-analysis

Fu,

Hu,

et al. 2023

Ital J Pediatr

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Extubation failure (EF) is a significant concern in mechanically ventilated newborns, and predicting its occurrence is an ongoing area of research. To investigate the predictors of EF in newborns undergoing planned extubation, we conducted a systematic review and meta-analysis. A systematic literature search was conducted in PubMed, Web of Science, Embase, and Cochrane Library for studies published in English from the inception of each database to March 2023. The PRISMA guidelines were followed in all phases of this systematic review. The Risk of Bias Assessment for Nonrandomized Studies tool was used to assess methodological quality. Thirty-four studies were included, 10 of which were overall low risk of bias, 15 of moderate risk of bias, and 9 of high risk of bias. The studies reported 43 possible predictors in six broad categories (intrinsic factors; maternal factors; diseases and adverse conditions of the newborn; treatment of the newborn; characteristics before and after extubation; and clinical scores and composite indicators). Through a qualitative synthesis of 43 predictors and a quantitative meta-analysis of 19 factors, we identified five definite factors, eight possible factors, and 22 unclear factors related to EF. Definite factors included gestational age, sepsis, pre-extubation pH, pre-extubation FiO2, and respiratory severity score. Possible factors included age at extubation, anemia, inotropic use, mean airway pressure, pre-extubation PCO2, mechanical ventilation duration, Apgar score, and spontaneous breathing trial. With only a few high-quality studies currently available, well-designed and more extensive prospective studies investigating the predictors affecting EF are still needed. In the future, it will be important to explore the possibility of combining multiple predictors or assessment tools to enhance the accuracy of predicting extubation outcomes in clinical practice.

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Section: Discussioncontrasting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Predictors of extubation failure in newborns: a systematic review and meta-analysis

Fu,

Hu,

et al. 2023

Ital J Pediatr

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“…Previous literature from 2014 documented a comparable population with an extubation failure rate of 25% ± 9% (mean ± standard deviation) [ 4 ]. More recent studies reported within the past two years, including those by Chen, Y.H., et al (21.66%) [ 28 ], He, F., et al (30.6%) [ 29 ], and Park, S.J., et al (18.6%) [ 30 ], also reported extubation failure rates in similar populations. These findings underscore the continued significance of extubation failure rates in such preterm infant populations.…”

Section: Discussionmentioning

confidence: 84%

Feasibility of Endotracheal Extubation Evaluation Form in Predicting Successful Extubation in Neonatal Intensive Care Units: A Retrospective Study

et al. 2023

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Given the limited availability of evidence-based methods for assessing the timing of extubation in intubated preterm infants, we aimed to standardize the extubation protocol in this single-center, retrospective study. To accomplish this, we established an extubation evaluation form to assess the suitability of extubation in preterm infants. The form comprises six indicators: improved clinical condition, spontaneous breath rate ≥ 30 breaths per minute, peak inspiratory pressure (PIP) ≤ 15 cmH2O, fraction of inspired oxygen (FiO2) ≤ 30%, blood pH ≥ 7.2, and mixed venous carbon dioxide tension (PvCO2) < 70 mmHg. Each positive answer is given one point, indicating a maximum of six points. We enrolled 41 intubated preterm infants (gestational age < 32 weeks, birth weight < 1500 g) who were receiving mechanical ventilation support for over 24 h. Among them, 35 were successfully extubated, and 6 were not. After completing the extubation evaluation form and adjusting for birth weight and postextubation device, we observed that the total score of the form was significantly associated with successful extubation; the higher the score, the greater the chance of successful extubation. Thus, we infer that the extubation evaluation form may provide a more objective standard for extubation assessment in preterm infants.

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“…Consequently, the definition of extubation readiness exhibits considerable variability 6–9 . Despite advances in neonatal care, extubation failure rate in preterm infants remains high, ranging from 10% to 80% 4 depending on the population studied, the criteria used to define extubation failure as well as the absence of a robust predictor tool 5,10 . In an attempt to identify predictors for successful extubation, Shalish et al conducted a systematic review, in which they identified 31 clinical predictors.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of lung ultrasound in predicting extubation failure in neonates: A systematic review and meta‐analysis

Mohsen

Solís-García

Jasani

et al. 2023

Pediatric Pulmonology

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ObjectiveTo systematically review and meta‐analyze the diagnostic accuracy of lung ultrasound score (LUS) in predicting extubation failure in neonates.Study DesignMEDLINE, COCHRANE, EMBASE, CINAHL, and clinicaltrials.gov were searched up to 30 November 2022, for studies evaluating the diagnostic accuracy of LUS in predicting extubation outcome in mechanically ventilated neonates.MethodologyTwo investigators independently assessed study eligibility, extracted data, and assessed study quality using the Quality Assessment for Studies of Diagnostic Accuracy 2 tool. We conducted a meta‐analysis of pooled diagnostic accuracy data using random‐effect models. Data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. We calculated pooled sensitivity and specificity, pooled diagnostic odds ratios with 95% confidence intervals (CI), and area under the curve (AUC).ResultsEight observational studies involving 564 neonates were included, and the risk of bias was low in seven studies. The pooled sensitivity and specificity for LUS in predicting extubation failure in neonates were 0.82 (95% CI: 0.75−0.88) and 0.83 (95% CI: 0.78−0.86), respectively. The pooled diagnostic odds ratio was 21.24 (95% CI: 10.45−43.19), and the AUC for LUS predicting extubation failure was 0.87 (95% CI: 0.80−0.95). Heterogeneity among included studies was low, both graphically and by statistical criteria (I2 = 7.35%, p = 0.37).ConclusionsThe predictive value of LUS in neonatal extubation failure may hold promise. However, given the current level of evidence and the methodological heterogeneity observed, there is a clear need for large‐scale, well‐designed prospective studies that establish standardized protocols for lung ultrasound performance and scoring.RegistrationThe protocol was registered in OSF (https://doi.org/10.17605/OSF.IO/ZXQUT).

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Predictors of extubation outcomes among extremely and very preterm infants: a retrospective cohort study

Cited by 10 publications

References 30 publications

Predictors of extubation failure in newborns: a systematic review and meta-analysis

Predictors of extubation failure in newborns: a systematic review and meta-analysis

Feasibility of Endotracheal Extubation Evaluation Form in Predicting Successful Extubation in Neonatal Intensive Care Units: A Retrospective Study

Accuracy of lung ultrasound in predicting extubation failure in neonates: A systematic review and meta‐analysis

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