WIP 10 - Lung ultrasound score to assess extubation success in neonates on invasive mechanical ventilation

Publication Number: WIP 10.7511

Ann Chacko, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Adam S. Bauer, University of Wisconsin School of Medicine and Public Health, MADISON, WI, United States; Eileen Cowan, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Whitley N. Hulse, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Michael R. Lasarev, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Eric Monroe, University of Wisconsin, Madison, WI, United States; Miranda Gathright, University of Minnesota Medical School, St Paul, MN, United States; Ellen Diego, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Marissa Paulson, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States; Brandon O'Connor, University of Minnesota Masonic Children's Hospital, Saint Paul, MN, United States; Rachel Mansky, University of Minnesota Medical School, Edina, MN, United States

Background: Point of care ultrasound (POCUS) is increasingly used in Neonatal Intensive Care Units (NICU) for lung pathology evaluation. Previous studies suggest neonatal POCUS pre-extubation lung scores help assess extubation success. Yet it is unclear whether lung POCUS assessment performed pre-extubation, post-extubation, or both best predict extubation success.

Objective: To evaluate the hypothesis that pre- and/or post-extubation lung ultrasound scores (LUSC) can predict extubation success in neonates with respiratory failure on mechanical ventilation.

Design/Methods: This is a prospective observational study of infants requiring mechanical ventilation due to respiratory failure and meeting predetermined extubation criteria based on clinical and laboratory parameters. The study is taking place at UnityPoint Health-Meriter Level III NICU and Fairview Masonic Children’s Hospital Level III NICU, with IRB approval from both institutions. Trained neonatal providers perform lung ultrasound within 24 hours prior and 72 hours post extubation. A board-certified pediatric radiologist ensures quality assurance. The medical team determining extubation timing is blinded to LUSC, ensuring no influence on clinical decisions. Extubation success is defined as remaining extubated for 7 days.

The primary outcome is to identify a pre-extubation score threshold for re-intubation. The secondary outcome examines whether the difference in pre- and post-extubation LUSC correlate with re-intubation needs. Data collection began in December 2023 and is expected to conclude by early 2025, with analysis finalized by March 2025. Data collection is complete for 45 patients to date.

Preliminary analysis of 21 patients shows a median pre-extubation LUSC of 9, with three re-intubations among those scoring above this median (p = 0.043; Fisher’s exact test). Statistical analysis will include descriptive statistics, inter-site comparisons, and multivariable logistic regression to identify factors significantly (p < 0.05) associated with successful extubation, presented as odds ratios with 95% confidence intervals.