Thoracic Fluid Content as a New Predictor of Successful Weaning in Neonates Compared to Lung Ultrasound

Abstract

Abstract Background Accurate timing for neonatal extubation is needed to avoid complications resulting from prolonged ventilation or extubation failure. No known universal predictors for successful weaning. Thoracic fluid content (TFC) by Electrical cardiometry can be used in this matter as lung congestion may cause extubation failure. Moreover, Lung Ultrasound Score (LUS) which assesses lung aeration can help in this matter. Aim of the Work This study aims to assess the accuracy of TFC as a predictor of successful weaning compared to LUS in neonates. Patients and Methods In this prospective observational study 62 invasively ventilated neonates were included. According to gestational age (GA), they were split into two equal groups group (1) < 34 weeks and group(2) > 34 weeks. Then both were compared as regards ventilation settings, TFC and LUS score on intubation and prior to extubation. Results Lower Postnatal age on initiation of mechanical ventilation (MV)(1-5 days versus 2- 15 days/P-value= 0.007) and longer duration on MV (1-18 days versus 1-7days /P-value= 0.007) were found in group (1) than group(2). In addition to higher respiratory rates (mean 70 BPM versus 67 BPM / P-value<0.001), Downes score(mean 7 versus 6 / P-value<0.001) and ventilation settings (means were PIP 16, PEEP 8,and FIO2 0.50) in group(1) versus (PIP 14, PEEP 7, FIO2 0.45) in group (2) with P-value 0.001) on initiation of ventilation. TFC mean was 44.35 kΩ−1in group (1) versus 42.5 kΩ−1 in group (2), LUS score mean was 6 in group (1) versus 5 in group(2). the both groups were comparable as regards TFC and LUS score. TFC and LUS score were positively correlated (r*=0.74). the best cut off value for TFC at which the neonate can be extubated successfully was < 41.5 kΩ−1 with sensitivity 75.3% and specificity 81.3%. the best cut off value for LUS score was < 5 with sensitivity 73.1% and specificity63.3%. Conclusion TFC and LUS score can be used as predictors of successful extubation in neonates.