2007 OPEN FORUM Abstracts
EXTUBATION TO NASAL CPAP IMPROVES THORACOABDOMINAL RESPIRATORY SYNCHRONY IN PREMATURE INFANTS
M. A. Stein1, T. Preston3, S. E. Welty1, P. Richardson2, L. G. Chicoine1, L. D. Nelin1
Background: Patients in the NICU often require endotracheal intubation. Intubation, although life-saving, may increase work during spontaneous breathing in patients recovering from lung disease. Changes in thoraco-abdominal asynchrony (TAA) have been associated with changes in work of breathing. To estimate qualitatively the effect of an endotracheal tube on work of breathing in premature infants we measured TAA using non-invasive respiratory impedance plethysmography (RIP) in neonates prior to and after extubation. We hypothesized that extubation would result in decreased work of breathing as evidenced by improvement in TAA as measured by the phase angle.
Methods: RIP was performed on premature patients immediately prior to and within 60 minutes following scheduled extubation. RIP bands were placed around the abdomen at the umbilicus and chest wall at the nipple line. Patients were placed on nasal continuous positive airway pressure (nCPAP) after extubation. The abdominal and chest wall movements during spontaneous respirations were analyzed using a Lissajous plot and phase angle was measured as previously described (Kiciman et al. Pediatr Pulmonol 25: 175-181, 1998). One-way ANOVA was used to analyze the data. The study was approved by the IRB.
Results: Paired RIP measurements before and after extubation were made in 8 premature infants. The mean birth weight was 873 Â± 349 grams, the mean gestational age at birth was 28 Â± 3 weeks and the mean age at extubation attempt was 16 Â± 17 days. All 8 extubation attempts were successful as defined by no re-intubation within 72 hours. The phase angle while intubated was 70.5 Â± 17.6 degrees and decreased (p<0.05) to 21.2 Â± 3.1 degrees after extubation. There was no difference in measured tidal volume, lung volume, respiratory rate or supplemental oxygen needs prior to or after extubation.
Conclusions: These results demonstrate that respiratory synchrony improved after removal of the endotracheal tube and placement on nCPAP in these premature infants. Placement of these premature infants on nCPAP did not worsen their respiratory status in terms of respiratory rate, FIO2, tidal volumes, or lung volumes. These results support the notion that work of breathing was decreased after removal of the endotracheal tube.