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. 2022 Oct;92(4):1064-1069.
doi: 10.1038/s41390-022-02085-w. Epub 2022 May 6.

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

Emma E Williams  1 , Fahad M S Arattu Thodika  1 , Imogen Chappelow  1 , Nicole Chapman-Hatchett  1 , Theodore Dassios  1   2 , Anne Greenough  3   4   5
Affiliations

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

Emma E Williams et al. Pediatr Res. 2022 Oct.

Abstract

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.

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Conflict of interest statement

A.G. is currently receiving a non-conditional educational grant from SLE.

Figures

Fig. 1
Fig. 1. Flow diagram of the included infants, with those who failed the SBT on the left and those who passed the SBT on the right of the figure.
Number of infants at each level shown in brackets.
Fig. 2
Fig. 2. Amplitude before and during SBT.
Amplitude in microvolts on the y-axis with the end of each box depicting the upper and lower quartiles, with the median marked by a horizontal line within the box. The whiskers mark the minimum and maximum values of amplitude.
Fig. 3
Fig. 3. Change in EMGAUC in less mature infants, showing the difference between those who fail extubation and those succeed.
Change in % EMGAUC on the y-axis with the end of each box depicting the upper and lower quartiles, with the median marked by a horizontal line within the box. The whiskers mark the minimum and maximum values of EMGAUC.
Fig. 4
Fig. 4. Flow diagram of infants <29 weeks who passed and failed extubation according to percentage change EMGAUC.
Number of infants at each level shown in brackets.
See this image and copyright information in PMC

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