Impact of Spontaneous Breathing Trials in Cardiorespiratory Stability of Preterm Infants

Nakato, Adriane Muller; Ribeiro, Débora de Fc; Simão, Ana Carolina; Silva, Regina Pgvc Da; Nohama, Percy

doi:10.4187/respcare.07955

Cited by 11 publications

(9 citation statements)

References 24 publications

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“… 26 In that study, however, the EMG was measured during invasive ventilatory support, which could have suppressed the respiratory drive and hence any difference in diaphragmatic function would not have been observed. The use of a spontaneous breathing trial (SBT) has been reported to be 97% sensitive but of low (40%) specificity in predicting readiness for extubation, 27 making use of an SBT alone not routinely recommended in preterm infants given the inaccuracy in predicting extubation failures 28 , 29 along with reports of clinical instability. We thus hypothesised that a combined measurement of the Edi during an SBT would increase the specificity of the assessment.…”

Section: Introductionmentioning

confidence: 99%

Diaphragmatic electromyography during a spontaneous breathing trial to predict extubation failure in preterm infants

et al. 2022

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Background Premature attempts at extubation and prolonged episodes of ventilatory support in preterm infants have adverse outcomes. The aim of this study was to determine whether measuring the electrical activity of the diaphragm during a spontaneous breathing trial (SBT) could predict extubation failure in preterm infants. Methods When infants were ready for extubation, the electrical activity of the diaphragm was measured by transcutaneous electromyography (EMG) before and during a SBT when the infants were on endotracheal continuous positive airway pressure. Results Forty-eight infants were recruited (median (IQR) gestational age of 27.2 (25.6–30.4) weeks). Three infants did not pass the SBT and 13 failed extubation. The amplitude of the EMG increased during the SBT [2.3 (1.5–4.2) versus 3.5 (2.1–5.3) µV; p < 0.001]. In the whole cohort, postmenstrual age (PMA) was the strongest predictor for extubation failure (area under the curve (AUC) 0.77). In infants of gestational age <29 weeks, the percentage change of the EMG predicted extubation failure with an AUC of 0.74 while PMA was not associated with the outcome of extubation. Conclusions In all preterm infants, PMA was the strongest predictor of extubation failure; in those born <29 weeks of gestation, diaphragmatic electromyography during an SBT was the best predictor of extubation failure. Impact Composite assessments of readiness for extubation may be beneficial in the preterm population. Diaphragmatic electromyography measured by surface electrodes is a non-invasive technique to assess the electrical activity of the diaphragm. Postmenstrual age was the strongest predictor of extubation outcome in preterm infants. The change in diaphragmatic activity during a spontaneous breathing trial in extremely prematurely born infants can predict subsequent extubation failure with moderate sensitivity and specificity.

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Section: Introductionmentioning

confidence: 99%

Diaphragmatic electromyography during a spontaneous breathing trial to predict extubation failure in preterm infants

et al. 2022

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“…In another retrospective study, the infants who failed extubation did not increase breathing frequency or work of breathing statistically significantly following a 3-min SBT compared to those infants with a successful extubation ( 17 ). The inability to compensate for the transiently increased cardiorespiratory load during a trial might be an indicator of cardiorespiratory function deterioration, which can lead to potentially catastrophic (sometimes fatal) consequences ( 18 – 20 ). Therefore, a reasonable assumption is that the infants required early reintubation (within 72 h) deteriorated clinically after initial extubation as a direct result of the removal of the ventilatory support provided during mechanical ventilation, such as atelectasis, apnea, and hemodynamic instability ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Time Interval Between First Extubation and Reintubation on Bronchopulmonary Dysplasia or Death in Very Low Birth Weight Infants

Zhang

Hao

et al. 2022

Front. Pediatr.

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ObjectiveTo explore the association between time from first extubation to reintubation and moderate-to-severe bronchopulmonary dysplasia (BPD) or death in very low birth weight infants.Study DesignInfants weighing <1,500 g at birth, requiring mechanical ventilation, and undergoing their initial extubation were retrospectively included from January 2014 to December 2021. They were divided into the moderate-to-severe BPD/death group and the comparison group according to the incidence of moderate-to-severe BPD or death. We defined time to reintubation as the time interval between first extubation and reintubation. In a stepwise multivariate logistic regression analysis, we examined the association between time to reintubation and moderate-to-severe BPD/death using different observation windows after initial extubation (24-h intervals).ResultsA total of 244 infants were recruited, including 57 cases in the moderate-severe BPD/death group and 187 cases in the comparison group, and 93 (38.1%) cases were reintubated at least one time after their first extubation. Univariate analysis showed that reintubation rates within different observation windows in the moderate-to-severe BPD/death group were statistically significantly (p < 0.05) higher than those in the comparison group. Multivariate regression analysis showed that reintubation within observation windows 48 h or 72 h post-extubation was an independent risk factor in moderate-to-severe BPD/death and death, but not moderate-to-severe BPD. When the time window was 48 h, the probability of moderate-to-severe BPD/death [odds ratio (OR): 3.778, 95% confidence interval (CI): 1.293–11.039] or death (OR: 4.734, 95% CI: 1.158–19.354) was highest. While after extending the observation window to include reintubations after 72 h from initial extubation, reintubation was not associated with increased risk of moderate-to-severe BPD and/or death.ConclusionsNot all reintubations conferred increased risks of BPD/death. Only reintubation within 72 h from initial extubation was independently associated with increased likelihood of moderate-to-severe BPD/death and death in very low birth weight infants, and reintubation within the first 48 h post-extubation posed the greatest risk.

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“…According to these studies, SBT has high sensitivity and positive predictive value but low specificity and negative predictive value in evaluating the neonates' readiness for extubation. Therefore, despite its low costs and availability, SBT cannot be considered a test with accurate results in assessing the neonates' readiness for extubation [24,[29][30][31]. The ability of SBT to predict success may be due to the increased resistance and dead space of the endotracheal tubes in small premature on CPAP, which increases the work of breathing.…”

Section: Spontaneous Breathing Trialmentioning

confidence: 99%

Weaning and extubation from neonatal mechanical ventilation: an evidenced-based review

et al. 2022

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Mechanical ventilation is a lifesaving treatment used to treat critical neonatal patients. It facilitates gas exchange, oxygenation, and CO2 removal. Despite advances in non-invasive ventilatory support methods in neonates, invasive ventilation (i.e., ventilation via an endotracheal tube) is still a standard treatment in NICUs. This ventilation approach may cause injury despite its advantages, especially in preterm neonates. Therefore, it is recommended that neonatologists consider weaning neonates from invasive mechanical ventilation as soon as possible. This review examines the steps required for the neonate's appropriate weaning and safe extubation from mechanical ventilation.

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Impact of Spontaneous Breathing Trials in Cardiorespiratory Stability of Preterm Infants

Cited by 11 publications

References 24 publications

Diaphragmatic electromyography during a spontaneous breathing trial to predict extubation failure in preterm infants

Diaphragmatic electromyography during a spontaneous breathing trial to predict extubation failure in preterm infants

The Impact of Time Interval Between First Extubation and Reintubation on Bronchopulmonary Dysplasia or Death in Very Low Birth Weight Infants

Weaning and extubation from neonatal mechanical ventilation: an evidenced-based review

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