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

Abstract

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.

Accuracy of lung and diaphragm ultrasound in predicting infant weaning outcomes: a systematic review and meta-analysis

“…The possibility of patient selection bias was mostly related to the fact that four studies included patients who were either eligible for weaning or planned to be weaned rather than patients who were randomly selected ( 21 , 24 , 25 , 29 ). Index test poses a risk since they do not clearly reveal whether the ultrasound was performed without knowledge of the clinical outcomes ( 21 , 23 , 27 , 28 , 31 ). Furthermore, the reference standard poses a danger due to the low success rate of clinical weaning events and the omission to identify whether clinical weaning decisions were taken without knowledge of ultrasound findings ( 22 , 27 , 28 , 29 , 30 , 31 ).…”

Lung and diaphragm ultrasound as predictors of successful weaning from nasal continuous positive airway pressure in preterm infants

“…In a recently published systematic review evaluating eight studies assessing the utility of LUS score in predicting extubation failure in neonates, the researchers concluded that LUS score can predict extubation failure with a pooled sensitivity and specificity of 0.82 and 0.87 respectively 7 . Abdelmawla et al 10 found that LUS could predict successful weaning from NCPAP. They assessed 39 infants with GA less than 33 weeks at three times points before weaning from NCPAP: third day of life, second week of, and within 24 h before weaning from NCPAP.…”

“…8,9 However, the literature assessing the rule of the LUS score in prediction of successful weaning from NCAPP in neonates is scarce, with only one prior study that previously evaluated the value of assessing the LUS score before discontinuing of NCPAP. 10 The diaphragm is the main muscle of respiration; thus, the evaluation of diaphragmatic function seems to be a promising tool in predicting successful weaning. Several studies have evaluated the value of assessing diaphragmatic excursion (DE) and thickness as predictors of successful weaning from mechanical ventilation in neonates, 11 children, 12,13 and adults 14 with promising results.…”

Application of ultrasonography in neonatal lung disease: An updated review

“…In addition, LUS performs a useful role in predicting non-invasive ventilation failure in neonates with respiratory distress, and this is important for the clinician to decide to apply invasive mechanical ventilation to prevent clinical deterioration ( 154 , 158 – 160 ). Based on the obtained LUS severity score, point-of-care LUS can predict the weaning readiness off nasal continuous positive airway pressure (NCPAP) in premature infants with evolving BPD ( 161 ) and also the success of extubation among ventilated neonates ( 162 – 164 ), thus avoiding their exposure to multiple unsuccessful weaning cycles. As described above, surfactant replacement therapy may be needed in neonates with serious respiratory disease, and early identification of this need is important.…”