Division of Experimental Medicine, McGill University Health Center, Montreal, QC, Canada.
Assistant Professor of Pediatrics, Division of Neonatology, McGill University Health Center, Montreal, QC, Canada.
Pediatr Res. 2023 May;93(6):1687-1693. doi: 10.1038/s41390-022-02284-5. Epub 2022 Sep 3.
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.
鼻持续气道正压通气、鼻间歇正压通气和非侵入性神经调节通气辅助是无创性呼吸支持的模式。本研究旨在探讨拔管后即刻进行的心肺测量是否与拔管结果相关，以及拔管成功的预测因素。
对 BW≤1250g 的首次拔管的婴儿进行随机交叉试验。拔管后不久，在每个模式下记录 40 分钟的心电图和膈肌电活动（Edi）。在每个模式上计算心率变异性（HRV）、膈肌活动（Edi 面积、呼吸面积和幅度）和呼吸变异性（RV）的指标，并比较拔管成功和失败（≤7 天内重新插管）婴儿之间的差异。
共纳入 23 名极早产儿，中位[IQR]胎龄 25.9 周[25.2-26.4]，BW 760g[595-900]：14 例成功，9 例失败。两组间 HRV（低频功率和样本熵）和 RV 指标（呼吸面积、幅度和呼气时间）差异有统计学意义，ROC 曲线下面积为 0.75-0.80，具有中等预测准确性。两组间膈肌活动指标相似。
在极早产儿拔管后接受无创呼吸支持时，几项心肺变异性参数与拔管成功相关，具有中等预测准确性。
在拔管后接受 NCPAP、NIPPV 和 NIV-NAVA 治疗的极早产儿中，心肺变异性测量值在拔管成功和失败的患者之间存在显著差异。心肺变异性测量值对拔管成功率具有中等预测准确性，可作为最近拔管的婴儿的生物标志物。未来在该人群中的研究也可以考虑在评估拔管后呼吸支持类型时包括心肺变异性测量值，并促进个体化护理。
