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Extubation generates lung volume inhomogeneity in preterm infants
  1. Risha Bhatia1,2,3,4,
  2. Hazel R Carlisle1,5,
  3. Ruth K Armstrong1,6,
  4. C Omar Farouk Kamlin1,2,
  5. Peter G Davis1,2,7,
  6. David G Tingay1,2,3,6
  1. 1 Newborn Research, The Royal Women's Hospital, Parkville, Victoria, Australia
  2. 2 Neonatal Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  3. 3 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  4. 4 Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia
  5. 5 Department of Neonatology, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia
  6. 6 Neonatology, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  7. 7 Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Risha Bhatia, Monash Newborn, Monash Children's Hospital, Clayton, VIC 3168, Australia; risha.bhatia{at}monashhealth.org

Abstract

Objective To evaluate the feasibility of electrical impedance tomography (EIT) to describe the regional tidal ventilation (VT) and change in end-expiratory lung volume (EELV) patterns in preterm infants during the process of extubation from invasive to non-invasive respiratory support.

Design Prospective observational study.

Setting Single-centre tertiary neonatal intensive care unit.

Patients Preterm infants born <32 weeks’ gestation who were being extubated to nasal continuous positive airway pressure as per clinician discretion.

Interventions EIT measurements were taken in supine infants during elective extubation from synchronised positive pressure ventilation (SIPPV) before extubation, during and then at 2 and 20 min after commencing nasal continuous positive applied pressure (nCPAP). Extubation and pressure settings were determined by clinicians.

Main outcome measures Global and regional ΔEELV and ΔVT, heart rate, respiratory rate and oxygen saturation were measured throughout.

Results Thirty infants of median (range) 2 (1, 21) days were extubated to a median (range) CPAP 7 (6, 8) cm H2O. SpO2/FiO2 ratio was a mean (95% CI) 50 (35, 65) lower 20 min after nCPAP compared with SIPPV. EELV was lower at all points after extubation compared with SIPPV, and EELV loss was primarily in the ventral lung (p=0.04). VT was increased immediately after extubation, especially in the central and ventral regions of the lung, but the application of nCPAP returned VT to pre-extubation patterns.

Conclusions EIT was able to describe the complex lung conditions occurring during extubation to nCPAP, specifically lung volume loss and greater use of the dorsal lung. EIT may have a role in guiding peri-extubation respiratory support.

  • neonatology
  • technology

Data availability statement

Data are available on reasonable request. Deidentified individual participant data, study protocols and statistical analysis codes are available from 3 months to 23 years following article publication to researchers who provide a methodologically sound proposal, with approval by an independent review committee ('learned intermediary'). Proposals should be directed to david.tingay@mcri.edu.au to gain access. Data requestors will need to sign a data access or material transfer agreement approved by MCRI.

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Data availability statement

Data are available on reasonable request. Deidentified individual participant data, study protocols and statistical analysis codes are available from 3 months to 23 years following article publication to researchers who provide a methodologically sound proposal, with approval by an independent review committee ('learned intermediary'). Proposals should be directed to david.tingay@mcri.edu.au to gain access. Data requestors will need to sign a data access or material transfer agreement approved by MCRI.

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Footnotes

  • Contributors RB, HRC, RKA, DGT and PGD developed the concept and experimental design. RB, HC, RKA and DGT were involved in data acquisition, analysis and interpretation. DGT, PGD and COFK supervised the study. RB and DGT drafted the first manuscript and all authors contributed to editing.

  • Funding This study was supported by a National Health and Medical Research Council Clinical Career Development Fellowship Grant ID 1053889 and Grant ID 1009287 (DGT), NHMRC Practitioner Fellowship Grant ID 556600 (DGT) NHMRC Program Grant ID 384100 and the Victorian Government Operational Infrastructure Support Program (Melbourne, Australia).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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