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Abstract
Objective To determine the accuracy of pre-extubation lung ultrasound (LUS) to predict reintubation in preterm infants born <32 weeks’ gestation.
Design Prospective diagnostic accuracy study.
Setting Two neonatal intensive care units.
Methods Anterior and lateral LUS was performed pre-extubation. The primary outcome was the accuracy of LUS scores (range 0–24) to predict reintubation within 72 hours. Secondary outcomes were accuracy in predicting (1) reintubation within 7 days, (2) reintubation stratified by postnatal age and (3) accuracy of lateral imaging only (range 0–12). Pre-specified subgroup analyses were performed in extremely preterm infants born <28 weeks’ gestation. Cut-off scores, sensitivities and specificities were calculated using receiver operating characteristic analysis and reported as area under the curves (AUCs).
Results One hundred preterm infants with a mean (SD) gestational age of 27.4 (2.2) weeks and birth weight of 1059 (354) g were studied. Thirteen were subsequently reintubated. The AUC (95% CI) of the pre-extubation LUS score for predicting reintubation was 0.63 (0.45–0.80). Accuracy was greater in extremely preterm infants: AUC 0.70 (0.52–0.87) and excellent in infants who were <72 hours of age at the time of extubation: AUC 0.90 (0.77–1.00). Accuracy was poor in infants who were >7 days of age. Lateral imaging alone demonstrated similar accuracy to scanning anterior and lateral regions.
Conclusions In contrast to previous studies, LUS was not a strong predictor of reintubation in preterm infants. Accuracy is increased in extremely preterm infants. Future research should focus on infants at highest risk of extubation failure and consider simpler imaging protocols.
Trial registration number Australian New Zealand Clinical Trials Registry: ACTRN12621001356853.
- Neonatology
- Respiratory Medicine
- Intensive Care Units, Neonatal
Data availability statement
Individual patient data collected during the study and the statistical analysis will be available beginning 3 months and ending 23 years after article publication to researchers who provide a methodologically sound proposal with approval by the investigators local independent review committee. Data will be available for analysis to achieve aims in the approved proposal. Proposals should be directed to Arun.Sett@thewomens.org.au; to gain access, data requestors will need to sign a data access or material transfer agreement approved by the Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Australia.
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Data availability statement
Individual patient data collected during the study and the statistical analysis will be available beginning 3 months and ending 23 years after article publication to researchers who provide a methodologically sound proposal with approval by the investigators local independent review committee. Data will be available for analysis to achieve aims in the approved proposal. Proposals should be directed to Arun.Sett@thewomens.org.au; to gain access, data requestors will need to sign a data access or material transfer agreement approved by the Newborn Research Centre, The Royal Women’s Hospital, Melbourne, Australia.
Footnotes
X @ArunSett, @katehodg18, @drbretty
Contributors AS contributed to conception and design of the study, acquired the ultrasound images, analysed and interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. AS is the guarantor. SRR contributed to conception and design of the study, reported the ultrasound images, contributed to analysis and interpretation of the data, and critically reviewed and revised the manuscript for important intellectual content. BJM, DGT and PGD contributed to conception and design of the study, contributed to analysis and interpretation of the data, and critically reviewed and revised the manuscript for important intellectual content. SMD developed the statistical analysis plan, contributed to analysis and interpretation of the data, and critically reviewed and revised the manuscript for important intellectual content. GWCF, AZ, KAH, AN, NT and PPLK contributed to acquisition of the data, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript and agree to be accountable for all aspects of the work.
Funding This study is supported by the Victorian Government Operational Infrastructure Support Program (Melbourne, Australia). AS is supported by a research grant from the Australasian Society of Ultrasound in Medicine (grant ID RG 2022/1), a PhD Scholarship from the Centre of Research Excellence in Newborn Medicine (NHMRC, Australia; GNT1153176) and the Research Training Program, University of Melbourne, Victoria, Australia. DGT is supported by a NHMRC Investigator Grant (GNT2008212). PGD is supported by a NHMRC Practitioner Fellowship (GNT556600). BJM is supported by a NHMRC Investigator Grant (GNT2016662).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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