Cardiorespiratory measures shortly after extubation and extubation outcomes in extremely preterm infants. 2023

Samantha Latremouille, and Monica Bhuller, and Wissam Shalish, and Guilherme Sant'Anna
Division of Experimental Medicine, McGill University Health Center, Montreal, QC, Canada.

Nasal continuous positive airway pressure, nasal intermittent positive pressure ventilation, and non-invasive neurally adjusted ventilatory assist are modes of non-invasive respiratory support. The objective was to investigate if cardiorespiratory measures performed shortly after extubation are associated with extubation outcomes and predictors of extubation success. Randomized crossover trial of infants with birth weight (BW) ≤ 1250 g undergoing their first extubation. Shortly after extubation, electrocardiogram and electrical activity of the diaphragm (Edi) were recorded during 40 min on each mode. Measures of heart rate variability (HRV), diaphragmatic activity (Edi area, breath area and amplitude), and respiratory variability (RV) were computed on each mode and compared between infants with extubation success or failure (reintubation ≤ 7 days). Twenty-three extremely preterm infants with median [IQR] gestational age 25.9 weeks [25.2-26.4] and BW 760 g [595-900] were included: 14 success and 9 failures. There were significant differences for HRV (very low-frequency power and sample entropy) and RV parameters (breath areas, amplitudes and expiratory times) between groups, with moderate strength (0.75-0.80 areas under ROC curves) in predicting success. Diaphragmatic activity measures were similar between groups. In extremely preterm infants receiving non-invasive respiratory support shortly after extubation, several cardiorespiratory variability parameters were associated with successful extubation with moderate predictive accuracy. Measures of cardiorespiratory variability, performed in extremely preterm infants while receiving NCPAP, NIPPV, and NIV-NAVA shortly after extubation, were significantly different between patients that succeeded or failed extubation. Cardiorespiratory variability measures had a moderate predictive accuracy for extubation success and can be potentially used as biomarkers, in recently extubated infants. Future investigations in this population may also consider including cardiorespiratory variability measures when assessing types of post-extubation respiratory support and promote individualized care.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D007385 Intermittent Positive-Pressure Ventilation Application of positive pressure to the inspiratory phase when the patient has an artificial airway in place and is connected to a ventilator. BIPAP Biphasic Intermittent Positive Airway Pressure,IPPV,Inspiratory Positive-Pressure Ventilation,Ventilation, Intermittent Positive-Pressure,Biphasic Intermittent Positive Airway Pressure,Inspiratory Positive Pressure Ventilation,Intermittent Positive Pressure Ventilation,Positive-Pressure Ventilation, Inspiratory,Positive-Pressure Ventilation, Intermittent,Ventilation, Inspiratory Positive-Pressure,Ventilation, Intermittent Positive Pressure
D001724 Birth Weight The mass or quantity of heaviness of an individual at BIRTH. It is expressed by units of pounds or kilograms. Birthweight,Birth Weights,Birthweights,Weight, Birth,Weights, Birth
D003964 Diaphragm The musculofibrous partition that separates the THORACIC CAVITY from the ABDOMINAL CAVITY. Contraction of the diaphragm increases the volume of the thoracic cavity aiding INHALATION. Respiratory Diaphragm,Diaphragm, Respiratory,Diaphragms,Diaphragms, Respiratory,Respiratory Diaphragms
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D045422 Continuous Positive Airway Pressure A technique of respiratory therapy, in either spontaneously breathing or mechanically ventilated patients, in which airway pressure is maintained above atmospheric pressure throughout the respiratory cycle by pressurization of the ventilatory circuit. (On-Line Medical Dictionary [Internet]. Newcastle upon Tyne(UK): The University Dept. of Medical Oncology: The CancerWEB Project; c1997-2003 [cited 2003 Apr 17]. Available from: http://cancerweb.ncl.ac.uk/omd/) Airway Pressure Release Ventilation,BiPAP Bilevel Positive Airway Pressure,BiPAP Biphasic Positive Airway Pressure,Bilevel Positive Airway Pressure,Biphasic Positive Airway Pressure,APRV Ventilation Mode,Bilevel Continuous Positive Airway Pressure,Biphasic Continuous Positive Airway Pressure,CPAP Ventilation,Nasal Continuous Positive Airway Pressure,nCPAP Ventilation,APRV Ventilation Modes,Ventilation Mode, APRV,Ventilation Modes, APRV,Ventilation, CPAP,Ventilation, nCPAP
D060666 Airway Extubation Removal of an endotracheal tube from the patient. Endotracheal Extubation,Extubation, Intratracheal,Tracheal Extubation,Airway Extubations,Endotracheal Extubations,Extubation, Airway,Extubation, Endotracheal,Extubation, Tracheal,Extubations, Airway,Extubations, Endotracheal,Extubations, Intratracheal,Extubations, Tracheal,Intratracheal Extubation,Intratracheal Extubations,Tracheal Extubations
D062071 Infant, Extremely Premature A human infant born before 28 weeks of GESTATION. Extremely Premature Infants,Extremely Preterm Infants,Extremely Premature Infant,Extremely Preterm Infant,Infant, Extremely Preterm,Infants, Extremely Premature,Infants, Extremely Preterm,Premature Infant, Extremely,Premature Infants, Extremely,Preterm Infant, Extremely,Preterm Infants, Extremely

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