283 - Accuracy of Neonatal Lung Ultrasound in Predicting Extubation Failure: A Systematic Review and Meta-Analysis

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 283
Publication Number: 283.344

Gonzalo Solis-Garcia, THE HOSPITAL FOR SICK CHILDREN, TORONTO, ON, Canada; Nada Mohsen, Mansoura University, Mansoura, Egypt; Bonny Jasani, The Hospital for Sick Children, Toronto, ON, Canada; Nehad Nasef, Faculty of Medicine University of Mansoura, Mansoura, Egypt; Adel Mohamed, Mount Sinai Hospital, Toronto, ON, Canada

Presenting Author(s)

Gonzalo Solis-Garcia, MD (he/him/his)

Fellow
THE HOSPITAL FOR SICK CHILDREN
TORONTO, Ontario, Canada

First Author(s)

Nada Mohsen, MD, Doctorate in Pediatrics (she/her/hers)

Lecturer of Pediatrics
Faculty of Medicine, Mansoura University, Mansoura, Egypt

Background:

Despite being life-saving intervention, both prolonged mechanical ventilation and extubation failure have been associated with short and long-term morbidities in neonates, especially in preterm infants. Timely extubation can be challenging owing to the absence of a robust predictor tool. Several studies have reported lung ultrasound as a promising tool for prediction of extubation readiness in neonates.

Objective:

To determine the accuracy of lung ultrasound score (LUS) in predicting extubation failure in neonates.

Design/Methods:

MEDLINE, COCHRANE, EMBASE, CINAHL, and clinicaltrials.gov were searched until November 2022 for studies evaluating the diagnostic accuracy of LUS in predicting extubation failure in mechanically ventilated neonates. Two reviewers independently determined study eligibility, extracted data, and assessed study quality using the Quality Assessment for Studies of Diagnostic Accuracy 2 (QUADAS 2) tool. Meta-analysis of pooled diagnostic accuracy data was performed using Review Manager 5.4.1 and R 4.1.0 (package mada). Data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Area under the curve (AUC), and pooled sensitivity and specificity with 95% confidence intervals were calculated.

Results:

Eight observational studies (N=607) with the overall risk of bias being low were included (Table 1). Lung ultrasound score for prediction of extubation failure in neonates had pooled sensitivity of 0.81 (95% CI 0.75 - 0.86) and specificity of 0.82 (95% CI 0.78 - 0.86). Heterogeneity among included studies was considered low after observing forest plot (Figure 1). Receiver operator characteristic curve showed an AUC of 0.886 (Figure 2).

Conclusion(s):

Lung ultrasound has good accuracy in predicting extubation failure in neonates. However, adequately powered randomized control trials are warranted to identify specific LUS cut off for translating it to clinical practice.