Prediction of extubation readiness using lung ultrasound in preterm infants

Soliman, Reem; Elsayed, Yasser; Said, Reem N.; Abdulbaqi, Abdulaziz; Hashem, Rania H.; Aly, Hany

doi:10.1002/ppul.25383

Cited by 19 publications

(19 citation statements)

References 35 publications

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“…POC‐LUS can objectively assess the degree of lung severity by a score which is the lung ultrasound severity score (LUSsc). LUSsc has shown predictability of extubation success in mechanically ventilated preterm infants 12 . This LUSsc has been validated in our animal lab with induced lung injury in a piglet model with a similar technique used in this study 13 …”

Section: Introductionmentioning

confidence: 83%

“…Other studies described the usefulness of POC‐LUS in predicting the need for invasive mechanical ventilation in infants supported with noninvasive ventilation and the need for surfactant replacement in nCPAP‐supported extremely preterm neonates 27 . Recently POC‐LUS described its usefulness in predicting the Success of extubation from mechanical ventilation in preterm infants 12 …”

Section: Discussionmentioning

confidence: 99%

“…Oxygen saturation index (OSI) was calculated based on the highest FiO 2 ; OSI = MAP × FiO 2 × 100/arterial oxygen saturation 20 . Respiratory severity score calculated as (FiO 2 × highest nCPAP) 12 …”

Section: Methodsmentioning

confidence: 99%

“…20 Respiratory severity score calculated as (FiO 2 × highest nCPAP). 12 2.4 | Stability criteria for weaning off nasal CPAP as per unit guidelines 5 1. nCPAP of 5 cm H 2 O.…”

Section: Clinical Respiratory Parametersmentioning

confidence: 99%

“…LUSsc has shown predictability of extubation success in mechanically ventilated preterm infants. 12 This LUSsc has been validated in our animal lab with induced lung injury in a piglet model with a similar technique used in this study. 13 POC-LUS has been the standard for lung assessment in our center for 5 years.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of weaning readiness off nasal CPAP in preterm infants using point‐of‐care lung ultrasound

Abdelmawla

Seleem

Farooqui

et al. 2022

Pediatric Pulmonology

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This study's primary aim was to assess whether end-expiratory lung ultrasound severity score (expLUSsc) at Day 3 of life, the second week of life, and before weaning off nasal continuous positive airway pressure (nCPAP) can predict the weaning readiness off nCPAP trial in preterm infants. The secondary aim was to evaluate the value of adding lung tidal recruitment (LTR) to expLUSsc (expLUSsc-plus-LTR) to improve predictability.We conducted a prospective study on premature infants <33 weeks of gestation. Pointof-care lung ultrasound (POC-LUS) was performed on Day 3, the second week of life, before and after the trial off nCPAP. expLUSsc, pleural thickness, and LTR were assessed.A receiver operator curve was constructed to evaluate the ability of POC-LUS to predict the weaning readiness off nCPAP. A total of 148 studies were performed on 39 infants, of them 12 weaned off nCPAP from the first trial and 27 infants failed attempts off nCPAP.An expLUSsc cut-off 8 before the first trial of weaning off nCPAP has a sensitivity and specificity of 88% and 90%, and positive and negative predictive values of 87% and 92%, respectively, with area under the curve (AUC) was 0.87 (CI: 0.8-0.93), p < .0001. If LTR is added to an expLUSsc cut-off 8 (expLUSsc-plus-LTR) before the first trial of weaning, then sensitivity and specificity of 95% and 90%, and positive and negative predictive values of 88% and 90%, respectively, with AUC was 0.95 (CI: 0.91-0.99), p < .0001. In conclusion, this study demonstrated the ability of POC-LUS to predict the weaning readiness off nCPAP in premature infants. The use of this simple bedside noninvasive test can potentially avoid the exposure of premature infants to multiple unsuccessful weaning cycles.

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Section: Introductionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…20 Respiratory severity score calculated as (FiO 2 × highest nCPAP). 12 2.4 | Stability criteria for weaning off nasal CPAP as per unit guidelines 5 1. nCPAP of 5 cm H 2 O.…”

Section: Clinical Respiratory Parametersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction of weaning readiness off nasal CPAP in preterm infants using point‐of‐care lung ultrasound

Abdelmawla

Seleem

Farooqui

et al. 2022

Pediatric Pulmonology

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Accuracy of lung and diaphragm ultrasound in predicting successful extubation in extremely preterm infants: A prospective observational study

Mohsen

Nasef

Ghanem

et al. 2022

Pediatric Pulmonology

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Objective: Chest ultrasound has emerged as a promising tool in predicting extubation readiness in adults and children, yet its utility in preterm infants is lacking. Our aim was to assess the utility of lung ultrasound severity score (LUSS) and diaphragmatic function in predicting extubation readiness in extremely preterm infants.Study Design: In this prospective cohort study, preterm infants < 28 weeks gestational age (GA) who received invasive mechanical ventilation for ≥12 h were enrolled. Chest ultrasound was performed before extubation. The primary outcome was lung ultrasound accuracy for predicting successful extubation at 3 days.Descriptive statistics and logistic regression were done using SPSS version 22.Results: We enrolled 45 infants, of whom 36 (80%) were successfully extubated.GA and postmenstrual age (PMA) at extubation were significantly higher in the successful group. The LUSS was significantly lower in the successful group compared to failed group (11.9 ± 3.2 vs. 19.1 ± 3.1 p < 0.001). The two groups had no statistically significant difference in diaphragmatic excursion or diaphragmatic thickness fraction. Logistic regression analysis controlling for GA and PMA at extubation showed LUSS was an independent predictor for successful extubation (odd ratio 0.46, 95% confidence interval [0.23-0.9], p = 0.02). The area under the receiver operating characteristic curve was 0.95 (p ˂ 0.001) for LUSS, and a cut-off value of ≥15 had 95% sensitivity and 85% specificity in detecting extubation failure. Conclusion:In extremely preterm infants, lung ultrasound has good accuracy for predicting successful extubation. However, diaphragmatic measurements were not reliable predictors.

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Prediction of respiratory distress severity and bronchopulmonary dysplasia by lung ultrasounds and transthoracic electrical bioimpedance

et al. 2022

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Prediction of extubation readiness using lung ultrasound in preterm infants

Cited by 19 publications

References 35 publications

Prediction of weaning readiness off nasal CPAP in preterm infants using point‐of‐care lung ultrasound

Prediction of weaning readiness off nasal CPAP in preterm infants using point‐of‐care lung ultrasound

Accuracy of lung and diaphragm ultrasound in predicting successful extubation in extremely preterm infants: A prospective observational study

Prediction of respiratory distress severity and bronchopulmonary dysplasia by lung ultrasounds and transthoracic electrical bioimpedance

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