El Amrousy Doaa, Elgendy Marwa, Eltomey Mohamed, Elmashad Abd Elrahman
Department of Pediatrics, Tanta University Hospital, Tanta, Egypt.
Department of Neonatology, Cleveland Clinic Children Hospital, Cleveland, Ohio.
Pediatr Pulmonol. 2020 Sep;55(9):2452-2456. doi: 10.1002/ppul.24934. Epub 2020 Jul 8.
Invasive mechanical ventilation (MV) is lifesaving for critically ill neonates. Limiting the duration of MV support is crucial. Lung ultrasonography is a bedside technique useful to predict weaning success in adults, but few data are available about its use in neonates. Our aim was to assess the value of lung ultrasonography to predict weaning success of the ventilated neonates.
This study included 80 neonates on MV suffering from different pulmonary diseases. All patients had lung ultrasound just before extubation and 6 hours after extubation. Lung ultrasound score (LUS) was calculated for all neonate. Blood gases and chest x-ray were performed just before extubation as well. All neonates were followed up for 48 hours after extubation for extubation failure (EF).
Eighteen neonates (22.5%) experienced EF. Neonates with EF had significantly lower gestational age, lower weight but significantly prolonged duration of MV, prolonged NICU stay, and higher mortality. LUS before and after extubation was significantly higher in neonates with EF than those with weaning success. Pre-extubation LUS had a sensitivity of 83% and a specificity of 88% to predict weaning success in neonates at a cutoff value ≤4. While, post-extubation LUS had a sensitivity of 89%, and a specificity of 90% to predict weaning success in neonates at a cutoff point ≤6.
Lung ultrasound is a rapid, noninvasive, repetitive, and reliable tool for predicting the weaning success of ventilated neonates.
有创机械通气（MV）对危重新生儿来说是挽救生命的手段。限制MV支持的时长至关重要。肺部超声是一种床边技术，有助于预测成人撤机的成功率，但关于其在新生儿中的应用数据较少。我们的目的是评估肺部超声对预测接受通气的新生儿撤机成功率的价值。
本研究纳入了80例因不同肺部疾病接受MV治疗的新生儿。所有患者在拔管前及拔管后6小时均进行了肺部超声检查。计算所有新生儿的肺部超声评分（LUS）。拔管前还进行了血气分析和胸部X光检查。所有新生儿在拔管后随访48小时，观察拔管失败（EF）情况。
18例新生儿（22.5%）发生EF。发生EF的新生儿胎龄显著更低、体重更低，但MV持续时间显著延长、新生儿重症监护病房（NICU）住院时间延长且死亡率更高。发生EF的新生儿拔管前后的LUS显著高于撤机成功的新生儿。拔管前LUS预测新生儿撤机成功的敏感度为83%，特异度为88%，截断值≤4。而拔管后LUS预测新生儿撤机成功的敏感度为89%，特异度为90%，截断点≤6。
肺部超声是预测接受通气的新生儿撤机成功的一种快速、无创、可重复且可靠的工具。
