Finally, A Tool to Address Extubation Anxiety!

Konduri, Girija G.; Lagatta, Joanne; Lakshminrusimha, Satyanarayana; Saugstad, Ola Didrik

doi:10.1038/s41372-019-0525-4

Cited by 3 publications

(4 citation statements)

References 10 publications

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“… 11 , 13 Successful extubation is dependent on the balance between the respiratory load, respiratory muscle strength, and respiratory drive. 17 , 18 Respiratory drive and the ability of the diaphragm to respond to an increased respiratory load are major determinants of extubation success in infants. 8 , 19 , 20 …”

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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“…30 These observations suggest that, in the context of premature infants who are highly vulnerable and can fail extubation due to many reasons, including respiratory and nonrespiratory causes, establishing good predictor tests for extubation readiness is even more difficult. 31,32 All of the studies used endotracheal CPAP to perform the test, with an equivalent PEEP preset by the clinical team on conventional mechanical ventilation. Several techniques are commonly used to conduct SBTs, including pressure support mode with or without PEEP, endotracheal CPAP, automatic tube compensation, and T-piece.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis

et al. 2020

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BACKGROUND: Few data are available on the use of spontaneous breathing trials (SBTs) in the neonatal population, despite advocacy of the practice in many neonatal ICUs. In this metaanalysis, we systematically reviewed the literature regarding the accuracy of SBTs as a predictor for extubation failure in premature infants. METHODS: Following the PRISMA recommendations, scientific articles were collected in December 2019 and January 2020 using PubMed, LILACS, Web of Science, Scopus, Google Scholar, OATD, and BDTD databases. The risk of bias in the studies included herein was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity and specificity of the studies were estimated using a mixed logistic regression model of 2 levels and a normal bivariate model. RESULTS: Six studies were included for qualitative and quantitative evaluation in this study. All SBTs were performed with endotracheal CPAP, with a total observation time of 3-5 min. The parameters for passing/failing the test were similar in 5 of the 6 studies and included bradycardia or desaturation during the test. The SBT showed a high pooled sensitivity (0.97, 95% CI 0.85-0.99), indicating proper identification of neonates "ready" for successful extubation. However, a low pooled specificity (0.40, 95% CI 0.24-0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. Heterogeneity of included studies was considerable for sensitivity and substantial for specificity. CONCLUSIONS: The SBT in premature infants can accurately predict extubation success but not extubation failure. Therefore, even though it is an attractive, practical, and easy-to-perform bedside assessment tool, there is a lack of evidence to support its use as an independent predictor of extubation failure in premature infants. Its routine use should be evaluated and monitored carefully.

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“…Given the lack of evidence, we cannot recommend routine SBT in preterm neonates, and even if performed, it should be 3 min maximum, as evidenced by an earlier trial 15 . While earlier extubation attempts can lead to early discharge and less BPD, 14 extubation failures have been associated with additional procedural risk and high mortality/BPD 16,17 . Hence, it is critically important to have a checklist, to optimise the timing and maximise the chance of successful extubation.…”

Section: Assessing Extubation Readiness and Forming An Extubation Che...mentioning

confidence: 99%

“…15 While earlier extubation attempts can lead to early discharge and less BPD, 14 extubation failures have been associated with additional procedural risk and high mortality/BPD. 16,17 Hence, it is critically important to have a checklist, to optimise the timing and maximise the chance of successful extubation. The elements assessed in any checklist are also chronological as specific measures need to be taken earlier than others to have a maximal impact.…”

Section: Assessing Extubation Readiness and Forming An Extubation Che...mentioning

confidence: 99%

Weaning of invasive ventilation in the neonatal intensive care: Towards standardising practice: A narrative review

Sur

Paria

2022

J Paediatrics Child Health

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To present a physiological algorithmic approach to weaning of invasive ventilation in the neonatal intensive care, focusing mainly on the preterm infant. Review of literature, consensus guidelines, expert commentaries and practice guidelines from individual units. Weaning of ventilation for extubation in the neonatal population must follow certain criteria but needs individualising based on disease process, timeline and physiology. Algorithms based on scenarios and modes of ventilation used might aid the clinician on the floor for decision‐making process.

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Finally, A Tool to Address Extubation Anxiety!

Cited by 3 publications

References 10 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

Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis

Weaning of invasive ventilation in the neonatal intensive care: Towards standardising practice: A narrative review

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