Is the Spontaneous Breathing Test a Reliable Predictor of Ventilated Neonatal Weaning?A Pilot Prospective Observational Study

Document Type : Original Article

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Department of Pediatrics; Faculty of Medicine, Ain Shams University. Cairo, Egypt.

Abstract

Background: It is still difficult to determine the best time to wean ventilated newborns in order to reduce the duration spent on the ventilator and prevent extubation failure. Particularly in low resource newborn intensive care units (NICU) with limited access to lung ultrasonography or more advanced technology, the spontaneous breathing test (SBT) is recommended to predict successful weaning. Aim of the study: Our study aims to validate SBT as a reliable objective test for mechanically ventilated neonates’ extubation success. Patients and Methods: Pilot prospective observational study done on 50 ventilated neonates 27-42 weeks’ gestation. 4 died while still intubated, 4 were accidentally extubated before SBT and 3 had pneumothorax and were excluded. The attending physician made the decision to wean the patient based on the patient's clinical condition, hemodynamic status, and venous blood gases. Prior to their extubation, the 39 patients had SBT, and the results were documented. According to the success or failure of the weaning trial, they were furtherly split into two groups. Results: We studied the 39 neonates who were split into success and failure groups according to their weaning trial. SBT was passed in 84.2% of the success group compared to 36.4% of the failure group. SBT has an accuracy of 76.7% with sensitivity of 63.6% and specificity of 84.2% in predicting successful extubation. Conclusion: SBT is a reliable test for determining if ventilated newborns are ready to wean. It can be included as the last stage of the NICU protocol for ventilation weaning.

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