Near-infrared spectroscopy for prediction of extubation success after neonatal cardiac surgery

Abstract

Introduction:Reliable predictors of extubation readiness are needed and may reduce morbidity related to extubation failure. We aimed to examine the relationship between changes in pre-extubation near-infrared spectroscopy measurements from baseline and extubation outcomes after neonatal cardiac surgery.Materials and Methods:In this retrospective cross-sectional multi-centre study, a secondary analysis of prospectively collected data from neonates who underwent cardiac surgery at seven tertiary-care children’s hospitals in 2015 was performed. Extubation failure was defined as need for re-intubation within 72 hours of the first planned extubation attempt. Near-infrared spectroscopy measurements obtained before surgery and before extubation in patients who failed extubation were compared to those of patients who extubated successfully using t-tests.Results:Near-infrared spectroscopy measurements were available for 159 neonates, including 52 with single ventricle physiology. Median age at surgery was 6 days (range: 1–29 days). A total of 15 patients (9.4 %) failed extubation. Baseline cerebral and renal near-infrared spectroscopy measurements were not statistically different between those who were successfully extubated and those who failed, but pre-extubation cerebral and renal values were significantly higher in neonates who extubated successfully. An increase from baseline to time of extubation values in cerebral oximetry saturation by ≥ 5 % had a positive predictive value for extubation success of 98.6 % (95%CI: 91.1–99.8 %).Conclusion:Pre-extubation cerebral near-infrared spectroscopy measurements, when compared to baseline, were significantly associated with extubation outcomes. These findings demonstrate the potential of this tool as a valuable adjunct in assessing extubation readiness after paediatric cardiac surgery and warrant further evaluation in a larger prospective study.

168: Descriptors of Failed Extubation in Norwood Patients Using Physiologic Data Streaming

“…The same cardiovascular construct can cause lower arterial oxygenation 10 minutes post-extubation (1-3, 6, 7, 14, 24-26, 30, 31). Other studies also found a reduction in renal NIRS during an extubation readiness trial and an increase in cerebral NIRS from baseline to extubation in congenital heart patients at risk of extubation failure (24,25). However, those studies did not assess speci cally the Norwood population.…”

Associations With Extubation Failure and Predictive Value of Risk Analytics Algorithms With Extubation Readiness Tests Following Congenital Cardiac Surgery

“…Although IDO 2 has previously been used in predicting cardiac arrest (36), this is the first report utilizing the risk analytics algorithms IDO 2 and IVCO 2 to predict extubation failure. Several studies have identified near-infrared spectroscopy (NIRS) as a useful adjunct to ERTs in predicting extubation failure (15, 16). IDO 2 uses NIRS in addition to a number of other physiologic and laboratory values to provide an estimation of inadequate oxygen delivery during weaning and discontinuation of MV.…”

“…Previously identified associations with extubation failure among CHD patients include longer MV duration, use of an uncuffed endotracheal tube, and airway anomalies (10, 12, 13). Currently available ERT protocols have primarily been evaluated in noncardiac patients (14) and generally focus on respiratory parameters without factoring in support that MV provides to nonrespiratory organ systems (15, 16). The primary aim of this study was to identify factors associated with extubation failure following cardiac surgery.…”

Predictores de extubación fallida en el paciente pediátrico y neonatal

“…Las mediciones de NIRS (espectroscopía cercana al infrarrojo) cerebral y somático no fueron estadísticamente diferentes entre los que fueron extubados con éxito y los que fallaron, pero los valores previos a la extubación fueron significativamente más altos en los recién nacidos que se extubaron con éxito. Un aumento de los valores NIRS cerebral en ≥ 5% desde el inicio de la ventilación hasta el momento de la extubación tuvo un valor predictivo positivo para el éxito de la extubación del 98,6% (IC del 95%: 91,1-99,8%) (43). Una disminución en el NIRS somático mínimo de al menos un 10% durante un ensayo de preparación para la extubación tienen una probabilidad 6 veces mayor de fracaso de la extubación (p = 0,02; 95 % IC, 1,26-29,8).…”