Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK.
Pediatr Res. 2022 Oct;92(4):1064-1069. doi: 10.1038/s41390-022-02085-w. Epub 2022 May 6.
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.
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.
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.
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.
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.
早产儿过早尝试拔管和长时间接受通气支持会导致不良结局。本研究旨在确定在经皮膈肌肌电图（EMG）监测下，自主呼吸试验（SBT）中测量膈肌电活动是否可以预测早产儿拔管失败。
当婴儿准备拔管时，在经气管内持续气道正压通气下进行 SBT 前和进行 SBT 时，通过经皮 EMG 测量膈肌的电活动。
共纳入 48 名婴儿（中位（IQR）胎龄为 27.2（25.6-30.4）周）。有 3 名婴儿未通过 SBT，13 名婴儿拔管失败。EMG 振幅在 SBT 期间增加[2.3（1.5-4.2）与 3.5（2.1-5.3）µV；p<0.001]。在整个队列中，校正胎龄（PMA）是拔管失败的最强预测因素（曲线下面积（AUC）为 0.77）。在胎龄<29 周的婴儿中，EMG 的百分比变化预测拔管失败的 AUC 为 0.74，而 PMA 与拔管结果无关。
在所有早产儿中，PMA 是拔管失败的最强预测因素；在胎龄<29 周的婴儿中，SBT 期间的膈肌 EMG 是拔管失败的最佳预测因素。
综合评估拔管准备情况可能对早产儿有益。表面电极测量的膈肌肌电图是评估膈肌电活动的一种非侵入性技术。PMA 是早产儿拔管结果的最强预测因素。极早产儿在自主呼吸试验中膈肌活动的变化可以预测随后拔管失败，具有中等敏感性和特异性。
