Value of lung ultrasonography to predict weaning success in ventilated neonates

Abstract

Background Invasive mechanical ventilation (MV) is lifesaving for critically ill neonates. Limiting the duration of MV support is crucial. Lung ultrasonography is a bedside technique useful to predict weaning success in adults, but few data are available about its use in neonates. Our aim was to assess the value of lung ultrasonography to predict weaning success of the ventilated neonates. Methods This study included 80 neonates on MV suffering from different pulmonary diseases. All patients had lung ultrasound just before extubation and 6 hours after extubation. Lung ultrasound score (LUS) was calculated for all neonate. Blood gases and chest x‐ray were performed just before extubation as well. All neonates were followed up for 48 hours after extubation for extubation failure (EF). Results Eighteen neonates (22.5%) experienced EF. Neonates with EF had significantly lower gestational age, lower weight but significantly prolonged duration of MV, prolonged NICU stay, and higher mortality. LUS before and after extubation was significantly higher in neonates with EF than those with weaning success. Pre‐extubation LUS had a sensitivity of 83% and a specificity of 88% to predict weaning success in neonates at a cutoff value ≤4. While, post‐extubation LUS had a sensitivity of 89%, and a specificity of 90% to predict weaning success in neonates at a cutoff point ≤6. Conclusion Lung ultrasound is a rapid, noninvasive, repetitive, and reliable tool for predicting the weaning success of ventilated neonates.

Lung ultrasound for early surfactant treatment: Development and validation of a predictive model

“…LUS has been proved to be useful for respiratory management in neonates. 11,21,22 The accuracy of the prediction of the LUS score for surfactant treatment found in our study is consistent with previous publications. [13][14][15] Despite using a different probe and the presence of few variations in LUS examinations, we found a similar LUS score cut-offpoint more than 8 for surfactant treatment and almost the same diagnostic accuracy when comparing with De Martino et al 14 We also assessed the accuracy of a simplified and quicker modified LUS score based on only four views to reduce the duration of the procedure, finding a good diagnostic accuracy with a cut-off point more than 4 for surfactant treatment.…”

“…LUS has been proved to be useful for respiratory management in neonates 11,21,22 . The accuracy of the prediction of the LUS score for surfactant treatment found in our study is consistent with previous publications 13–15 .…”

Quantitative assessment of COVID‐19 pneumonia in neonates using lung ultrasound score

“…LUSS is well correlated with indices of oxygenation in both term and preterm neonates, 18 guiding surfactant therapy and weaning ventilator support. 19 LUSS could assess global and regional lung aeration, and well correlated with CT quantitative analysis indices 20 in ARDS. In the present study, the global LUSS was obviously higher in the COVID-19 group, in consistent with patients' symptoms.…”

Hemodynamic effects of high‐frequency oscillatory ventilation in preterm neonates with respiratory distress syndrome

“…Neonatal respiratory distress syndrome (NRDS) is one of the major problems among newborns and a major reason for increased morbidity and mortality among infants. 1,2 Conventional mechanical ventilation (MV) may be unable to maintain adequate gas exchange in critically ill neonates and may even aggravate immature lung injury by repetitive opening and collapse or overdistension of alveoli. 3 High-frequency oscillatory ventilation (HFOV) is a type of MV that has been reported to improve gas exchange and alveolar ventilation in neonates with RDS as an alternative to conventional MV.…”