103 - Observational pilot study to compare Edi metrics in premature infants requiring invasive mechanical ventilation versus those who are management with non-invasive respiratory support
Friday, April 25, 2025
5:30pm – 7:45pm HST
Publication Number: 103.5763
Pradeep Mally, New York University Grossman School of Medicine, New York, NY, United States; Sarah Fleishaker, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Tatiana Nuzum, The Hospital for Sick Children, Toronto, ON, Canada; Sean M. Bailey, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States
Director, Neonatology New York University Grossman School of Medicine New York, New York, United States
Background: In neonatology, many of our patients require respiratory support for a variety of pathologies. There is little data regarding objective parameters to help guide respiratory support. Decisions regarding optimal level of support for each patient remains largely subjective. Electrical activity of the diaphragm is a measure of neural respiratory drive and inspiratory load. This could be a useful tool to provide objective data regarding respiratory status which in turn could help guide decision making regarding optimal respiratory support. Objective: Primary objective of this study was to compare Edi metrics in those infants who required invasive mechanical ventilation with those infants who remained on non-invasive modes of ventilation. Secondary objective was to compare rates of BPD and severity of BPD in the two groups. Design/Methods: Prospective, pilot, observational study. Infants admitted to the NICU at NYU Langone or Bellevue Hospital, born at gestational age of 26-32 weeks and weighing >500 grams, were eligible for the study. Edi catheter placed within the first 24 hours of life and stayed in place for 72 hours. Subjects were weaned or escalated on their respiratory support based on current unit practice guidelines. Subjects separated into 2 groups: those who required invasive mechanical ventilation and those who did not. Paired student T-tests, chi-square tests, and Mann-Whitney tests were used to evaluate for statistical significance (p≤0.05). Results: 29 subjects were enrolled; 15 in the intubated group and 14 in the non-invasive group. Edi min was significantly lower and delta Edi was higher in the non-intubated group. There was no difference in Edi peaks, though there was a trend towards the non-invasive group have higher peaks (Table 1). BPD outcomes were not statistically different (Table 2).
Conclusion(s): The lower Edi min in the non-intubated group suggests less severe lung disease and more mild RDS, and therefore less stimulus and external support required to generate adequate distending pressure to maintain alveolar patency at end expiration. Their higher delta Edi suggests more intrinsic ability to generate an adequate tidal volume for ventilation (Figure 1). There is wide variation in practice regarding modes of ventilation, both invasive and noninvasive, with no clear ‘best practice’. We are lacking objective data to guide our practice. This study is the first to look at Edi metrics as a monitoring tool to assess degree of disease severity and sufficiency of support provided. Our results suggest that its use may provide more data to help standardize and guide clinical practice.
