Diaphragmatic activity and neural breathing variability during a 5-min endotracheal continuous positive airway pressure trial in extremely preterm infants

Samantha Latremouille, Monica Bhuller, Smita Rao, Wissam Shalish, Guilherme Sant'Anna
<span title="2020-09-17">2020</span> <i title="Springer Science and Business Media LLC"> <a target="_blank" rel="noopener" href="https://fatcat.wiki/container/whvfa7dwcjdv3htgapecctdu2q" style="color: black;">Pediatric Research</a> </i> &nbsp;
Extremely preterm infants are often exposed to endotracheal tube continuous positive airway pressure (ETT-CPAP) trials to assess extubation readiness. The effects of ETT-CPAP trial on their diaphragmatic activity (Edi) and breathing variability is unknown. Prospective observational study enrolling infants with birth weight ≤1250 g undergoing their first extubation attempt. Diaphragmatic activity, expressed as the absolute minimum (Edi min) and maximum values (Edi max), area under the Edi
more &raquo; ... and breath-by-breath analyses for breath areas, amplitudes, widths, and neural inspiratory and expiratory times, were analyzed during mechanical ventilation (MV) and ETT-CPAP. Neural breathing variability of each of these parameters was also calculated and compared between MV and ETT-CPAP. Thirteen infants with median (interquartile range) birth weight of 800 g [610-920] and gestational age of 25.4 weeks [24.4-26.3] were included. Diaphragmatic activity significantly increased during ETT-CPAP when compared to MV:Edi max (44.2 vs. 38.1 μV), breath area (449 vs. 312 μV·s), and amplitude (10.12 vs. 7.46 μV). Neural breathing variability during ETT-CPAP was characterized by increased variability for amplitude and area under the breath, and decreased for breath time and width. A 5-min ETT-CPAP in extremely preterm infants undergoing extubation imposed significant respiratory load with changes in respiratory variability. ETT-CPAP trials are often used to assess extubation readiness in extremely preterm infants, but its effects upon their respiratory system are not well known.Diaphragmatic activity analysis demonstrated that these infants are able to mount an important response to a short trial.A 5-min trial imposed a significant respiratory load evidenced by increased diaphragmatic activity and changes in breathing variability.Differences in breathing variability were observed between successful and failed extubations, which should be explored further in extubation readiness investigations.This type of trial cannot be recommended for preterm infants in clinical practice until clear standards and accuracy are established.Fig. 1ELECTRICAL ACTIVITY OF THE DIAPHRAGM SIGNAL ANALYSIS.: Example of electrical activity of the diaphragm (Edi) signal analysis to obtain the maximum Edi (Edi max), minimum Edi (Edi min), breath amplitudes, and widths.Fig. 2NEURAL BREATHING VARIABILITY AND EXTUBATION OUTCOMES.: MV mechanical ventilation, ETT-CPAP endotracheal tube continuous positive airway pressure, CV coefficient of variation, NTi neural inspiratory time, SDSD standard deviation of successive differences, BB breath to breath. Respiratory variability parameters during MV and ETT-CPAP significantly differ between infants with extubation success (S) or failure (F); p value *<0.05 and **<0.01 using the Wilcoxon's rank sum.
<span class="external-identifiers"> <a target="_blank" rel="external noopener noreferrer" href="https://doi.org/10.1038/s41390-020-01159-x">doi:10.1038/s41390-020-01159-x</a> <a target="_blank" rel="external noopener" href="https://www.ncbi.nlm.nih.gov/pubmed/32942291">pmid:32942291</a> <a target="_blank" rel="external noopener" href="https://pubmed.ncbi.nlm.nih.gov/PMC7533985/">pmcid:PMC7533985</a> <a target="_blank" rel="external noopener" href="https://fatcat.wiki/release/w4rctdssj5hbnjqkmqrryzdqnm">fatcat:w4rctdssj5hbnjqkmqrryzdqnm</a> </span>
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