A Model for Predicting Extubation Success in Premature Babies

  • STATUS
    Recruiting
  • End date
    Apr 20, 2024
  • participants needed
    114
  • sponsor
    Marmara University
Updated on 27 October 2021

Summary

Invasive mechanical ventilation is a life-saving treatment in critically ill newborns with respiratory failure. However, continuing this treatment for a long time may have negative consequences, especially bronchopulmonary dysplasia (BPD) secondary to mechanotrauma. For this reason, it is essential to terminate the mechanical ventilation treatment at the most appropriate time.

About half of the extremely preterm babies may fail extubation even if the clinical criteria traditionally used for extubation are met. Unsuccessful extubation is associated with increased intraventricular bleeding, death, BPD, death or BPD, longer duration of ventilator support.

When respiratory failure and lung pathologies of extremely preterm babies begin to improve, the target for mechanical ventilation should be early and successful extubation. Currently, the decision to extubate a preterm baby is primarily based on clinical judgment. Only a few studies that showed the low predictive value and limited utility using different measures have evaluated readiness for extubation. Lung ultrasonography (USG) is a noninvasive bedside technique that has been found useful for predicting the success of weaning from the ventilator in adults; however, very little data are available in neonates. In a recently published study, it was proposed an extubation readiness estimation tool based on clinical and demographic data of preterm babies who were attempted elective extubation.

The researchers' hypothesis is that the use of a model based on extubation success scoring and lung USG scoring before extubation reduces the failure of the first extubation attempt in very low birth weight infants. The aim of the study is to evaluate the value of using an integrated model based on pre-extubation "extubation readiness predictor" and lung USG scoring to predict extubation success in preterm babies undergoing invasive mechanical ventilation.

Description

Long-term invasive mechanical ventilation may have detrimental effects in preterm infants, although it is a life-saving treatment in critically ill newborns with respiratory failure. (e.g. bronchopulmonary dysplasia (BPD), superimposed bacterial infections and colonization, air leak, etc.). For this reason, it is essential to terminate the mechanical ventilation treatment at the most appropriate time.

A significant portion of the extremely preterm babies may fail extubation even if the clinical criteria traditionally used for extubation are met. Unsuccessful extubation is associated with increased intraventricular bleeding, death, BPD, death or BPD, longer duration of ventilator support.

When respiratory failure and lung pathologies of extremely preterm babies begin to improve, the target for mechanical ventilation should be early and successful extubation. Currently, the decision to extubate a preterm baby is primarily based on clinical judgment. Only a few studies that showed the low predictive value and limited utility using different measures have evaluated readiness for extubation. Lung ultrasonography (USG) is a noninvasive bedside technique that has been found useful for predicting the success of weaning from the ventilator in adults; however, very little data are available in neonates. In a recently published study, it was proposed an extubation readiness estimation tool based on clinical and demographic data of preterm babies who were attempted elective extubation.

The researchers' hypothesis is that the use of a model based on extubation success scoring and lung USG scoring before extubation; reduces the failure of the first extubation attempt in very low birth weight infants. The aim of the study is to evaluate the value of using a model based on pre-extubation "extubation readiness predictor" and lung USG scoring to predict extubation success in preterm babies undergoing invasive mechanical ventilation.

This study is a prospective observational study. The study is planned to be conducted in infants with a birth weight <1250 g, who were intubated within the first 7 days of life, remained intubated invasive conventional mechanical ventilation for at least 48 hours, did not complete the postnatal 60 days, and met the traditional extubation criteria of the institution and were considered for elective extubation for the first time.

An "informed consent form" will be obtained from the parents of the babies included in the study. The birth dates, protocol numbers, birth types, maternal histories, genders, weeks of gestation and birth weights of the babies will be recorded.

The usual institutional routine approaches will be applied after the baby is born.

Details
Condition Neonatal Respiratory Failure, Invasive Mechanical Ventilation, Extubation Failure
Treatment A model for predicting extubation success based on extubation readiness estimator and lung ultrasonography score
Clinical Study IdentifierNCT05081973
SponsorMarmara University
Last Modified on27 October 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Birth weight <1250 gr
Being intubated within the first 7 days of life and then followed on mechanical ventilation
Being intubated for at least 48 hours
Not completing the postnatal 60 days
Meeting conventional clinical extubation criteria
Having planned extubation for the first time
Having no air leakage occurred
Having no structural heart and lung disease
Having no congenital and chromosomal anomalies
Having an intact diaphragm
Having no PVL, IVH (Grade 2 and above), HIE, meningitis or known CNS anomaly during extubation

Exclusion Criteria

Infants with a gestational age of 34 weeks or more
Infants with unplanned and spontaneous extubation
Infants who have tried extubation before
Infants with hydrops fetalis
Infants with chest deformities
Infants with central respiratory failure (insufficient respiratory effort/control or continuous apneic)
Infants who are neurologically depressed and do not have spontaneous breathing (hypocarbia due to hyperventilation, presence of severe sedation, use of neuromuscular drugs)
In the presence of genetic or congenital anomalies (esophageal atresia, severe diaphragmatic hernia, diaphragm paralysis)
Having phrenic nerve damage
Presence of congenital myopathy
Having any air leakage
Having structural heart and lung disease
Having no intact diaphragm
Having PVL, IVH (Grade 2 and above), HIE, meningitis or known CNS anomaly during extubation
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