Diaphragmatic electromyography during a spontaneous breathing trial to predict extubation failure in preterm infants.
Journal
Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714
Informations de publication
Date de publication:
10 2022
10 2022
Historique:
received:
20
09
2021
accepted:
26
03
2022
revised:
04
03
2022
pubmed:
7
5
2022
medline:
26
10
2022
entrez:
6
5
2022
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
IMPACT
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.
Identifiants
pubmed: 35523885
doi: 10.1038/s41390-022-02085-w
pii: 10.1038/s41390-022-02085-w
pmc: PMC9586868
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1064-1069Subventions
Organisme : Medical Research Council
ID : G1000758
Pays : United Kingdom
Informations de copyright
© 2022. The Author(s).
Références
Rubarth, L. B. & Quinn, J. Respiratory development and respiratory distress syndrome. Neonatal Netw. 4, 231–238 (2015).
doi: 10.1891/0730-0832.34.4.231
Venkatesh, V. et al. Endotracheal intubation in a neonatal population remains associated with a high risk of adverse events. Eur. J. Pediatr. 170, 223–227 (2011).
pubmed: 20842378
doi: 10.1007/s00431-010-1290-8
Laughon, M. M. et al. Prediction of bronchopulmonary dysplasia by postnatal age in extremely premature infants. Am. J. Respir. Crit. Care Med. 183, 1715–1722 (2011).
pubmed: 21471086
pmcid: 3136997
doi: 10.1164/rccm.201101-0055OC
Chawla, S. et al. Markers of successful extubation in extremely preterm infants, and morbidity after failed extubation. J. Pediatr. 189, 113–119 (2017).
pubmed: 28600154
pmcid: 5657557
doi: 10.1016/j.jpeds.2017.04.050
Manley, B. J., Doyle, L. W., Owen, L. S. & Davis, P. G. Extubating extremely preterm infants: predictors of success and outcomes following failure. J. Pediatr. 173, 45–49 (2016).
pubmed: 26960919
doi: 10.1016/j.jpeds.2016.02.016
Gupta, D. et al. A predictive model for extubation readiness in extremely preterm infants. J. Perinatol. 39, 1663–1669 (2019).
pubmed: 31455825
doi: 10.1038/s41372-019-0475-x
Bhat, P., Peacock, J. L., Rafferty, G. F., Hannam, S. & Greenough, A. Prediction of infant extubation outcomes using the tension-time index. Arch. Dis. Child. Fetal Neonatal Ed. 101, F444–F447 (2016).
pubmed: 26802111
doi: 10.1136/archdischild-2015-309264
Dimitriou, G., Greenough, A., Endo, A., Cherian, S. & Rafferty, G. F. Prediction of extubation failure in preterm infants. Arch. Dis. Child. Fetal Neonatal Ed. 86, F32–F35 (2002).
pubmed: 11815545
pmcid: 1721344
doi: 10.1136/fn.86.1.F32
Kavvadia, V., Greenough, A. & Dimitriou, G. Prediction of extubation failure in preterm neonates. Eur. J. Pediatr. 159, 227–231 (2000).
pubmed: 10789923
doi: 10.1007/s004310050059
Eissa, A. et al. Use of extubation bundle including modified spontaneous breathing trial (SBT) to reduce the rate of reintubation, among preterm neonates ≤ 30 weeks. J. Neonatal Perinat. Med. 13, 359–366 (2020).
doi: 10.3233/NPM-190236
Giaccone, A., Jensen, E., Davis, P. & Schmidt, B. Definitions of extubation success in very premature infants: a systematic review. Arch. Dis. Child. Fetal Neonatal Ed. 99, F124–F127 (2014).
pubmed: 24249694
doi: 10.1136/archdischild-2013-304896
Hermeto, F., Martins, B. M., Ramos, J. R., Bhering, C. A. & Sant’Anna, G. M. Incidence and main risk factors associated with extubation failure in newborns with birth weight <1,250 grams. J. Pediatr. 85, 397–402 (2009).
doi: 10.1590/S0021-75572009000500005
Shalish, W. et al. Patterns of reintubation in extremely preterm infants; a longitudinal cohort study. Pediatr. Res. 88, 969–975 (2018).
doi: 10.1038/pr.2017.330
Dimitriou, G., Fouzas, S., Vervenioti, A., Tzifas, S. & Mantagos, S. Prediction of extubation outcome in preterm infants by composite extubation indices. Pediatr. Crit. Care Med. 12, e242–e249 (2011).
pubmed: 21037500
doi: 10.1097/PCC.0b013e3181fe3431
Shalish, W., Latremouille, S., Papenburg, J. & Sant’Anna, G. M. Predictors of extubation readiness in preterm infants: a systematic review and meta-analysis. Arch. Dis. Child. Fetal Neonatal Ed. 104, F89–F97 (2019).
pubmed: 29519808
doi: 10.1136/archdischild-2017-313878
Beltempo, M. et al. Respiratory management of extremely preterm infants: an international survey. Neonatology 114, 28–36 (2018).
pubmed: 29656287
doi: 10.1159/000487987
Konduri, G. G., Lagatta, J., Lakshminrusimha, S. & Saugstad, O. D. Finally, a tool to address extubation anxiety! J. Perinatol. 39, 1581–1583 (2019).
pubmed: 31624323
pmcid: 7751659
doi: 10.1038/s41372-019-0525-4
Greenough, A. & Currie, A. in Pediatric and Neonatal Mechanical Ventilation: From Basics to Clinical Practice (ed. Rimensberger, P. C.) 1425–1431 (Springer Berlin Heidelberg, 2015).
Kamlin, C. O., Davis, P. G. & Morley, C. J. Predicting successful extubation of very low birthweight infants. Arch. Dis. Child. Fetal Neonatal Ed. 91, F180–F183 (2006).
pubmed: 16410255
pmcid: 2672700
doi: 10.1136/adc.2005.081083
Singh, N., McNally, M. J. & Darnall, R. A. Does diaphragmatic electrical activity in preterm infants predict extubation success? Respir. Care 63, 203–207 (2018).
pubmed: 29184049
doi: 10.4187/respcare.05539
Pang, P. C., Pepper, M. G. & Ducker, D. A. Monitoring respiratory activity in neonates using diaphragmatic electromyograph. Med. Biol. Eng. Comput. 33, 385–390 (1995).
pubmed: 7666684
doi: 10.1007/BF02510520
Liu, L. et al. Neuroventilatory efficiency and extubation readiness in critically ill patients. Crit. Care 16, R143 (2012).
pubmed: 22849707
pmcid: 3580730
doi: 10.1186/cc11451
Wolf, G., Walsh, B., Green, M. & Arnold, J. Electrical activity of the diaphragm during extubation readiness testing in critically ill children. Pediatr. Crit. Care Med. 12, e220–e224 (2010).
doi: 10.1097/PCC.0b013e3181fe28fc
Ducharme-Crevier, L., Du Pont-Thibodeau, G. & Emeriaud, G. Interest of monitoring diaphragmatic electrical activity in the pediatric intensive care unit. Crit. Care Res. Pract. 2013, 384210 (2013).
pubmed: 23509617
pmcid: 3594948
van Leuteren, R. W. et al. Diaphragm activity pre and post extubation in ventilated critically ill infants and children measured with transcutaneous electromyography. Pediatr. Crit. Care Med. 22, 950–959 (2021).
pubmed: 34534162
doi: 10.1097/PCC.0000000000002828
Hunt, K. A., Hunt, I., Ali, K., Dassios, T. & Greenough, A. Prediction of extubation success using the diaphragmatic electromyograph results in ventilated neonates. J. Perinat. Med. 48, 609–614 (2020).
pubmed: 32598319
doi: 10.1515/jpm-2020-0129
Teixeira, R. F. et al. Spontaneous breathing trials in preterm infants: systematic review and meta-analysis. Respir. Care 66, 129–137 (2021).
pubmed: 32843509
doi: 10.4187/respcare.07928
Nakato, A. M., Ribeiro, D., Simao, A. C., Da Silva, R. & Nohama, P. Impact of spontaneous breathing trials in cardiorespiratory stability of preterm infants. Respir. Care 66, 286–291 (2021).
pubmed: 32994356
doi: 10.4187/respcare.07955
Shalish, W. et al. Assessment of extubation readiness using spontaneous breathing trials in extremely preterm neonates. JAMA Pediatr. 174, 178–185 (2020).
pubmed: 31860014
doi: 10.1001/jamapediatrics.2019.4868
Manley, B. J. et al. High-flow nasal cannulae in very preterm infants after extubation. N. Engl. J. Med. 369, 1425–1433 (2013).
pubmed: 24106935
doi: 10.1056/NEJMoa1300071
Dassios, T., Kaltsogianni, O. & Greenough, A. Relaxation rate of the respiratory muscles and prediction of extubation outcome in prematurely born infants. Neonatology 112, 251–257 (2017).
pubmed: 28704815
doi: 10.1159/000477233
LeSouef, P. N., England, S. J. & Bryan, A. C. Total resistance of the respiratory system in preterm infants with and without an endotracheal tube. J. Pediatr. 104, 108–111 (1984).
pubmed: 6361227
doi: 10.1016/S0022-3476(84)80605-8
Wang, S. H. et al. Risk factors for extubation failure in extremely low birth weight infants. Pediatr. Neonatol. 58, 145–150 (2017).
pubmed: 27349301
doi: 10.1016/j.pedneo.2016.01.006
Jeffreys, E., Hunt, K., Dassios, T. & Greenough, A. Diaphragm electromyography results at different high flow nasal cannula flow rates. Eur. J. Pediatr. 178, 1237–1242 (2019).
pubmed: 31187264
pmcid: 6647435
doi: 10.1007/s00431-019-03401-z
Kraaijenga, J. V., Hutten, G. J., de Jongh, F. H. & van Kaam, A. H. The effect of caffeine on diaphragmatic activity and tidal volume in preterm infants. J. Pediatr. 167, 70–75 (2015).
pubmed: 25982138
doi: 10.1016/j.jpeds.2015.04.040
Iyer, N. P. et al. Neural breathing pattern in newborn infants pre- and postextubation. Acta Paediatr. 106, 1928–1933 (2017).
pubmed: 28833570
doi: 10.1111/apa.14040
Supinski, G. S. & Ann Callahan, L. Diaphragm weakness in mechanically ventilated critically ill patients. Crit. Care 17, R120 (2013).
pubmed: 23786764
pmcid: 3840677
doi: 10.1186/cc12792
Dimitriou, G., Greenough, A., Rafferty, G. & Moxham, J. Effect of maturity on maximal transdiaphragmatic pressure in infants during crying. Am. J. Respir. Crit. Care Med. 164, 433–436 (2001).
pubmed: 11500345
doi: 10.1164/ajrccm.164.3.2004176
Latremouille, S., Bhuller, M., Rao, S., Shalish, W. & Sant’Anna, G. Diaphragmatic activity and neural breathing variability during a 5-min endotracheal continuous positive airway pressure trial in extremely preterm infants. Pediatr. Res. 89, 1810–1817 (2021).
pubmed: 32942291
doi: 10.1038/s41390-020-01159-x
Oda, A., Parikka, V., Lehtonen, L., Porres, I. & Soukka, H. Nasal high-flow therapy decreased electrical activity of the diaphragm in preterm infants during the weaning phase. Acta Paediatr. 108, 253–257 (2019).
pubmed: 29959864
doi: 10.1111/apa.14485
Davis, P. G. & Henderson-Smart, D. J. Extubation from low-rate intermittent positive airways pressure versus extubation after a trial of endotracheal continuous positive airways pressure in intubated preterm infants. Cochrane Database Syst. Rev. 4, CD001078 (2001).
Barwing, J., Pedroni, C., Olgemöller, U., Quintel, M. & Moerer, O. Electrical activity of the diaphragm (EAdi) as a monitoring parameter in difficult weaning from respirator: a pilot study. Crit. Care 17, R182 (2013).
pubmed: 23985299
pmcid: 4057029
doi: 10.1186/cc12865
Dres, M. et al. Diaphragm electromyographic activity as a predictor of weaning failure. Intensive Care Med. 38, 2017–2025 (2012).
pubmed: 23011532
doi: 10.1007/s00134-012-2700-3
Wang, M. et al. Research on EMG segmentation algorithm and walking analysis based on signal envelope and integral electrical signal. Photonic Netw. Commun. 37, 195–203 (2019).
doi: 10.1007/s11107-018-0809-1
Dassios, T., Vervenioti, A. & Dimitriou, G. Respiratory muscle function in the newborn: a narrative review. Pediatr. Res. 19, 1–9 (2021).
Wang, S. H. et al. Risk factors for extubation failure in extremely low birth weight infants. Pediatr. Neonatol. 58, 145–150 (2017).
pubmed: 27349301
doi: 10.1016/j.pedneo.2016.01.006
Vento, G. et al. Spontaneous minute ventilation is a predictor of extubation failure in extremely-low-birth-weight infants. J. Matern. Fetal Neonatal Med. 15, 147–154 (2004).
pubmed: 15280139
doi: 10.1080/14767050410001668239
Society, A. T. ATS/ERS Statement on respiratory muscle testing. Am. J. Respir. Crit. Care Med. 166, 518–624 (2002).
doi: 10.1164/rccm.166.4.518