Diaphragmatic electromyography during a spontaneous breathing trial to predict extubation failure in preterm infants

• Published in: Pediatric research Vol. 92; no. 4; pp. 1064 - 1069
• Main Authors: Williams, Emma E., Arattu Thodika, Fahad M. S., Chappelow, Imogen, Chapman-Hatchett, Nicole, Dassios, Theodore, Greenough, Anne
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.10.2022; Nature Publishing Group
• Subjects: Airway Extubation - adverse effects; Airway Extubation - methods; Clinical; Clinical Research Article; Continuous positive airway pressure; Diaphragm; Electromyography; Extubation; Gestational age; Humans; Infant; Infant, Newborn; Infant, Premature; Medicine; Medicine & Public Health; Newborn babies; Pediatric Surgery; Pediatrics; Premature babies; Ventilator Weaning - adverse effects; Ventilator Weaning - methods
• ISSN: 0031-3998; 1530-0447
• DOI: 10.1038/s41390-022-02085-w

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.