Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt.
Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Pediatr Pulmonol. 2024 May;59(5):1428-1437. doi: 10.1002/ppul.26933. Epub 2024 Mar 19.
Assessment of the utility of lung and diaphragm ultrasound in the prediction of successful weaning from nasal continuous positive airway pressure (NCPAP) in preterm infants.
This prospective cohort study was conducted on preterm infants who were considered ready for weaning off NCPAP. Lung and diaphragm ultrasound were performed just before and 3 h after weaning off NCPAP. The primary outcome was to evaluate the accuracy of lung ultrasound (LUS) in predicting successful weaning from NCPAP.
Out of 65 enrolled preterm infants, 30 (46.2%) were successfully weaned from NCPAP to room air. The successful weaning group had higher gestational ages, lower incidences of previous invasive mechanical ventilation, and treated hemodynamically significant patent ductus arteriosus before the trial weaning. A LUS score of ≤6, measured before discontinuation of NCPAP, exhibited a predictive sensitivity of 80% and specificity of 75% for successful weaning (Area under the curve (AUC) = 0.865, ≤.001). When the LUS score was assessed 3 h after weaning from NCPAP, a cutoff point of ≤7 predicted successful weaning with a sensitivity and specificity of 90% and 60% respectively (AUC = 0.838, p ≤ .001). The diaphragmatic thickness fraction (DTF) was significantly lower in the successful weaning group. After adjustment for various factors, LUS score remained the only independent predictor of successful weaning.
LUS score before weaning from NCPAP has a good sensitivity and specificity for predicting successful weaning from NCPAP in preterm infants. Diaphragmatic excursion and DTF were not good predictors.
评估肺部和膈肌超声在预测早产儿经鼻持续气道正压通气（NCPAP）撤机成功中的作用。
本前瞻性队列研究纳入了即将撤机的早产儿。在撤机前和撤机后 3 小时进行肺部和膈肌超声检查。主要结局是评估肺部超声（LUS）预测 NCPAP 撤机成功的准确性。
在纳入的 65 例早产儿中，30 例（46.2%）成功从 NCPAP 转为常压通气。撤机成功组的胎龄较大，既往有创机械通气发生率较低，试验撤机前接受了治疗性的动脉导管未闭。在停止使用 NCPAP 前测量的 LUS 评分≤6 分，对撤机成功的预测敏感性为 80%，特异性为 75%（曲线下面积（AUC）=0.865，<.001）。在撤机后 3 小时评估 LUS 评分时，≤7 的截点预测撤机成功的敏感性和特异性分别为 90%和 60%（AUC=0.838，p≤.001）。撤机成功组的膈肌厚度分数（DTF）显著降低。在校正了各种因素后，LUS 评分仍然是撤机成功的唯一独立预测因素。
在撤机前的 LUS 评分对预测早产儿 NCPAP 撤机成功具有良好的敏感性和特异性。膈肌运动幅度和 DTF 不是很好的预测指标。
