Lung Ultrasonography as Tool for Follow Up of Ventilated Neonates for Prediction of Weaning Readiness

Abstract

Background Timing is crucial when deciding if a patient can be successfully extubated. Both premature discontinuation and unnecessary delay of mechanical ventilation weaning have been associated with poor outcome. There are no enough guidelines for the assessment of readiness of newborns for extubation. The degree of lung aeration loss in different clinical conditions can be quantified via lung ultrasound (LUS). Objectives To evaluate the lung ultrasound score as a follow up tool in ventilated neonates and its validity as predictor of extubation. Subjects and Methods Prospective study done on 39 mechanically ventilated neonates 27-42 weeks’ gestation. Lung ultrasound was done daily for each patient till the day of weaning and lung ultrasound (LUS) score was calculated. Patients were divided into 2 groups according to trial of weaning; Success “S” group: in which weaning succeeded and Failure “F” group: in which weaning failed. Results The “F” group had significantly higher LUS score at time of intubation, pre- extubation and post-extubation compared with the “S” group (P- value= 0.002, 0.003 and 0.001 respectively). A cut off value of ≤ 10 for LUS score pre-extubation predict successful weaning with sensitivity 76% and specificity 64.3%. Conclusion LUS is an indicator for lung aeration and can be used as a tool to predict success of weaning of ventilated neonates.

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

“…Several meta‐analysis have described the varying diagnostic capabilities of LU in conditions such as transient tachypnea of the newborn, 14–16 respiratory distress syndrome (RDS), 17,18 bronchopulmonary dysplasia, 19 and early surfactant replacement prediction 20,21 . Moreover, recent studies have indicated that LU is a promising tool for prediction of extubation outcomes (success or failure) in neonates 22–29 . These recent findings in neonates are consistent with recent systematic review in adults which concluded that LU can assist in determining the ideal time for extubation 30 .…”

“…The literature search retrieved 659 potential records. After removing duplicates, screening abstracts, and evaluating subsequent full texts, 8 studies comprising 564 neonates [22][23][24][25][26][27][28][29] were included in the metaanalysis. A detailed flow diagram outlining the study inclusion process is shown in Figure 1.…”

“…Amongst the eight included studies, seven were prospective and one was retrospective in nature. 27 While six of the included studies were fully published, 22,23,25,[27][28][29] the remaining two were conference abstracts 24,26 for which the authors provided additional data upon request. Of the eight studies, four included both preterm and term infants, while the remaining four studies focused on preterm infants.…”

“…A low risk of bias was assigned to the domains of "patient selection" and "reference test." In the domain of "index test," five studies [23][24][25][26]29 were deemed to have low risk of bias, as details about scan performance and assessor blinding were confirmed. One study 22 was assigned a high risk of bias, while the risk was unclear for the remaining studies.…”

“…Regarding the "flow and timing" domain, low risk of bias was assigned to four studies. 22,24,27,29 Unclear risk of bias was assigned to the other four studies 23,25,26,28 due to the absence of a flow diagram to the study population and failure to clarify the excluded cases through personal communication. Regarding applicability, all included studies were applicable.…”