Utility of Spontaneous Breathing Trial (SBT) Using ET-CPAP, in Predicting Extubation Failure in Neonates

Intubation and ventilation are lifesaving interventions in the neonatal intensive care unit (ICU), especially among preterm, low birth weight babies. However, timely extubation is also necessary, in order to prevent adverse effects of prolonged intubation, such as iatrogenic pneumothorax, superadded bacterial infections and colonization, subglottic injury and bronchopulmonary dysplasia1,2.

For extubation to be successful, baby should maintain hemodynamic stability and O2 saturation for at least 48 hours post-extubation. So far there are no standard guidelines, especially in low resource countries such as ours, to predict successful extubation. The decision to extubate usually depends on clinical judgement, appropriate blood gas prior to extubation and low ventilator parameters3. Intensivists may vary in their experience and training, resulting in a large variation in the timing and outcome of extubation.

Research from high income settings indicates that approximately 40 % of babies extubated on the above criteria require re-intubation, suggesting that current methods to predict extubation failure are insufficient.3 Readiness for extubation can be objectively measured by observing pulmonary functions, respiratory muscle strength, respiratory drive, ventilator flow volumes and gas exchange.5,6 Re-intubation causes prolonged hospital stay, adversely effects the family, and results in undesirable effects on the neonate4 . Therefore accurate prediction of extubation failure in neonates is a high priority. Spontaneous breathing trial (SBT) has been predominantly used in infant and children to access the readiness for extubation . Few studies in premature neonates have also shown good sensitivity and specificity in predicting extubation sucess7.However its significance in our population is yet to be determined. We aim to use this for both our preterm and term babies and if results are significant we plan to include this as our routine pre extubation criteria.

Primary Objective:

To evaluate the usefulness of SBT, in predicting extubation failure among neonates admitted to a NICU in a tertiary care hospital in Karachi, Pakistan.