Accuracy of Spontaneous Breathing Trial Using ET-CPAP in Predicting Successful Extubation of Neonates.

Azeem Khan,Syed Rehan Ali,Erum Choudry,Muhammad Khalid,Ali Shabbir Hussain,Fayaz Ahmed,Anum Rahim,Sheharyar Khan,Vikram Kumar

doi:10.7759/cureus.17711

Abstract

Objective: Extubation failure is common in mechanically ventilated neonates. Finding objective criteria for predicting successful extubation may help to reduce the incidence of failure and the length of mechanical ventilation (MV). We conducted this study to determine the accuracy of the spontaneous breathing trial (SBT) and lung function measurements in predicting successful extubation in neonates. Methodology: This cross-sectional validation study was conducted at a tertiary care neonatal intensive care unit (NICU) over 12 months from December 2019 to December 2020. Neonates intubated for >24 hours and considered ready for extubation were enrolled in the study. Neonates who met defined eligibility criteria underwent a three minutes SBT using endotracheal continuous positive airway pressure (ET-CPAP) before extubation. The primary clinical team was blinded to the results, and all neonates were extubated after SBT. Extubation was considered successful if patients remained extubated for 48 hours.Results: Among the 107 infants, 77.5% (n=83) of infants passed the SBT. Of these, 78 were successfully extubated, giving the positive predictive value of 93.97%. The overall extubation success rate was 90% (n=96). The sensitivity and specificity of SBT were 81.2% and 54.5%, respectively. VE (ET-CPAP) and VE-ventilator at a cutoff of ≥238 ml and ≥143.7 ml have an area under the curve (AUC) of 0.77 and 0.75 respectively to predict successful extubation (p-value 0.003, 0.008 respectively). Conclusion: SBT predicts extubation success with pronounced accuracy. Therefore, we propose SBT as a valuable and crucial step that guides clinicians' decision-making regarding extubation preparedness or impending failure in neonates.

Highlights

Neonates with respiratory failure frequently require invasive mechanical ventilation (MV) and endotracheal intubation to ensure appropriate gas exchange and oxygenation after birth [1]
VE (ET-CPAP) and VEventilator at a cutoff of ≥238 ml and ≥143.7 ml have an area under the curve (AUC) of 0.77 and 0.75 respectively to predict successful extubation (p-value 0.003, 0.008 respectively)
Compared to neonates who passed their spontaneous breathing trial (SBT), those who failed belonged to the lower gestational age category, birth weight

Summary

Introduction

Neonates with respiratory failure frequently require invasive mechanical ventilation (MV) and endotracheal intubation to ensure appropriate gas exchange and oxygenation after birth [1]. Timely extubation is necessary to avoid adverse effects of prolonged endotracheal intubation and MV, such as iatrogenic pneumothorax, ventilator-associated pneumonia, secondary bacterial infections, airway trauma, sepsis, and bronchopulmonary dysplasia (BPD) [2,3]. Premature extubation can cause impaired gas exchange, respiratory muscle exhaustion, lung collapse, and the eventual need for reintubation [5]. Extubation decisions are frequently made in an ad hoc manner, based on clinical experience, observation of pulmonary functions, respiratory muscle strength, and the existence of clinical and hemodynamic stability [6]

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Discussion

Conclusion