None listed
Conditions
Brief summary
Babies who are born early (premature babies) often require help with their breathing. Some premature babies will require a breathing tube (intubation) and help from a breathing machine (ventilator). A ventilator helps babies to stay alive but may damage their lungs. To minimise this damage, we try to take the breathing tube out (extubate) as soon as possible. Unfortunately, some babies will not succeed and require the breathing tube to be put back in (reintubation). These babies are likely to be sicker in the long term than those who are successfully extubated. There are few tools available to help predict which babies will fail extubation. Ultrasound is a form of imaging that uses reflected sound to create an image of different parts of the body. It is safe, painless and does not use radiation. Ultrasound can be used to image the lungs of babies. We are exploring whether a lung ultrasound performed before a baby is extubated will help us predict extubation failure. We are also exploring if repeated lung ultrasound will give us more information on how a baby’s lungs behave after being extubated. Additionally, we are exploring two new types of ultrasound, one of a baby’s diaphragm (the main muscle of breathing) and one of their vocal cords. In this study, we will perform and ultrasound of a baby’s lungs and diaphragm before and after extubation and then daily for the next three days. We will also perform one vocal cord ultrasound 24 hours after extubation. We will use this information to see if we can predict which babies will require reintubation.
Interventions
Mechanically ventilated infants will be assessed for eligibility for study recruitment. Infants will either be extubated to nasal continuous positive airway pressure (nCPAP), non-invasive positive pressure ventilation (NIPPV), nasal high flow therapy (nHFT) or to no respiratory support at the treating team’s discretion. Infant will receive ultrasounds before and after extubation as described below.
Lung ultrasound
Infants will receive a LUS within 1 hour of extubation and 30 minutes after e
Mechanically ventilated infants will be assessed for eligibility for study recruitment. Infants will either be extubated to nasal continuous positive airway pressure (nCPAP), non-invasive positive pressure ventilation (NIPPV), nasal high flow therapy (nHFT) or to no respiratory support at the treating team’s discretion. Infant will receive ultrasounds before and after extubation as described below. Lung ultrasound Infants will receive a LUS within 1 hour of extubation and 30 minutes after extubation, then daily for 72 hours post extubation. Subsequent LUS will be performed within 6 hours of the original extubation time. LUS images will be reported and assigned global aeration scores, quadrant specific scores of atelectasis and measurements of depth of atelectasis if present. The treating team will remain blind to LUS findings. LUS images will be obtained using a GE Venue Go or Vivid S6 or Venue 50 (GE Healthcare, USA) ultrasound system with a “hockey stick,” L8-18i linear transducer set at a depth of 2cm and a gain of 60. Three second video clips will be acquired. M-mode imaging will be performed with each ultrasound clip with the m-mode cursor being applied between the rib spaces to capture pleural sliding. Each LUS will take approximately 5 minutes. Diaphragm ultrasound Diaphragm ultrasound (DUS) will be performed with the infant in the supine position. The treating team will remain blinded to the DUS findings. The probe will be placed in the midclavicular line in the right subcostal region. Only the right hemidiaphragm will be studied due to the limited acoustic window the left hemidiaphragm. Peak velocity of right diaphragmatic contraction will be obtained via tissue doppler imaging of the right hemidiaphragm . Diaphragm thickness will be measured using m-mode imaging. DUS will be performed at the same time points as LUS. Each DUS will take approximately 5 minutes. Vocal cord ultrasound A single Vocal cord ultrasound (VUS) will be performed 24 hours after extubation with infants in the supine position. The treating team will remain blind to the VUS findings. VUS will be obtained a “hockey stick,” L8-18i linear transducer. Normal vocal cord function will be determined by the presence of complete adduction (centrally inverted “T” formed by the vocal cord folds) and complete abduction (centrally inverted “V. For an objective measurement, we will measure the maximum distance of abduction at the base of the vocal cords. VUS will take approximately 5 minutes.
Sponsors
The Royal Women's Hospital
Study design
Allocation
Non-randomised trial
Primary purpose
Diagnosis
Eligibility
Sex/Gender
All
Age
4 Hours to No maximum
Healthy volunteers
No
Inclusion criteria
All infants born < 32 weeks and/or < 1250g who are mechanically ventilated for > 4 hours will be considered eligible
Exclusion criteria
• Congenital lung malformations including congenital diaphragmatic hernia • Genetic conditions that affect respiratory drive or effort • Congenital upper airway anomalies. • Previous participation in EXODUS
Outcome results
None listed