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  • Clinical Research Article
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Cardiorespiratory measures shortly after extubation and extubation outcomes in extremely preterm infants

Pediatric Research volume 93, pages 1687–1693 (2023)Cite this article

Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

Impact:

  • 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.

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Fig. 1: Heart rate variability, modes of non-invasive respiratory support, and extubation outcomes.
Fig. 2: Respiratory variability, modes of non-invasive respiratory support, and extubation outcomes.

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Research data are not shared.

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Funding

This work was supported by the Montreal Children’s Foundation research funds for G.S. In addition, S.L. and W.S. were both supported from Fonds de la recherche en sante du Quebec (FRQS) doctoral research awards in partnership with the Fondation Des Étoiles.

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Authors and Affiliations

  1. Division of Experimental Medicine, McGill University Health Center, Montreal, QC, Canada

    Samantha Latremouille & Monica Bhuller

  2. Assistant Professor of Pediatrics, Division of Neonatology, McGill University Health Center, Montreal, QC, Canada

    Wissam Shalish

  3. Professor of Pediatrics, Division of Neonatology, McGill University Health Center, Montreal, QC, Canada

    Guilherme Sant’Anna

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  1. Samantha Latremouille
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  3. Wissam Shalish
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  4. Guilherme Sant’Anna
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Contributions

S.L. assisted in patient screening and enrollment, was responsible for data acquisition, analyzed the data, and drafted the manuscript. M.B. assisted in patient screening and enrollment, and data acquisition. W.S. assisted in patient screening, enrollment, and data acquisition, and provided critical input into study design, data analyses, and writing of the manuscript. G.S. supervised the design and execution of the study, and provided critical input into the final data analyses and writing of the manuscript. All authors critically reviewed and approved the manuscript.

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Correspondence to Guilherme Sant’Anna.

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Latremouille, S., Bhuller, M., Shalish, W. et al. Cardiorespiratory measures shortly after extubation and extubation outcomes in extremely preterm infants. Pediatr Res 93, 1687–1693 (2023). https://doi.org/10.1038/s41390-022-02284-5

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