TY - JOUR
T1 - Diaphragmatic electromyography during a spontaneous breathing trial to predict extubation failure in preterm infants
AU - Williams, Emma
AU - Arattu Thodika, Fahad
AU - Chappelow, Imogen
AU - Chapman-Hatchett, Nicole
AU - Dassios, Theodore
AU - Greenough, Anne
N1 - Funding Information:
A prospective study was undertaken in the neonatal intensive care unit at King’s College Hospital NHS Foundation Trust between 22 June 2020 and 10 July 2021. The South West - Central Bristol Research Ethics Committee and Health Research Authority approved the study (REC reference 20/SW/0062) and parents gave written, informed consent for their infants to take part in the study. Infants born prior to 37 completed weeks of gestation were eligible for recruitment if receiving invasive mechanical ventilation. Infants with congenital lung or diaphragmatic anomalies were excluded. Ventilatory support was provided by the SLE6000 ventilator (SLE Ltd, Croydon, UK) via shouldered Cole’s endotracheal tubes. Patient-triggered volume-targeted ventilation, with target tidal volumes of 5–7 ml/kg, was used. Positive end expiratory pressures (PEEPs) of 5–6 cmHO were used for all infants, as per the Unit’s protocol. Low-dose morphine infusion (5–10 mcg/kg/h) was used for sedation in infants who were thought to be in pain, irrespective of their gestational age. Infants were extubated when the morphine infusion was stopped or was at a dose of 5 mcg/kg/h. 2
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85130061688&partnerID=8YFLogxK
U2 - 10.1038/s41390-022-02085-w
DO - 10.1038/s41390-022-02085-w
M3 - Article
SN - 0031-3998
VL - 92
SP - 1064
EP - 1069
JO - Pediatric Research
JF - Pediatric Research
IS - 4
ER -