ObjectiveAssessment of the utility of lung and diaphragm ultrasound in the prediction of successful weaning from nasal continuous positive airway pressure (NCPAP) in preterm infants.Study DesignThis prospective cohort study was conducted on preterm infants who were considered ready for weaning off NCPAP. Lung and diaphragm ultrasound were performed just before and 3 h after weaning off NCPAP. The primary outcome was to evaluate the accuracy of lung ultrasound (LUS) in predicting successful weaning from NCPAP.ResultsOut of 65 enrolled preterm infants, 30 (46.2%) were successfully weaned from NCPAP to room air. The successful weaning group had higher gestational ages, lower incidences of previous invasive mechanical ventilation, and treated hemodynamically significant patent ductus arteriosus before the trial weaning. A LUS score of ≤6, measured before discontinuation of NCPAP, exhibited a predictive sensitivity of 80% and specificity of 75% for successful weaning (Area under the curve (AUC) = 0.865, ≤.001). When the LUS score was assessed 3 h after weaning from NCPAP, a cutoff point of ≤7 predicted successful weaning with a sensitivity and specificity of 90% and 60% respectively (AUC = 0.838, p ≤ .001). The diaphragmatic thickness fraction (DTF) was significantly lower in the successful weaning group. After adjustment for various factors, LUS score remained the only independent predictor of successful weaning.ConclusionLUS score before weaning from NCPAP has a good sensitivity and specificity for predicting successful weaning from NCPAP in preterm infants. Diaphragmatic excursion and DTF were not good predictors.

中文翻译：

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肺和膈肌超声作为早产儿经鼻持续气道正压成功脱机的预测因素

目的评估肺部和膈肌超声在预测早产儿经鼻持续气道正压通气 (NCPAP) 成功脱机中的效用。研究设计本前瞻性队列研究针对已准备好脱机 NCPAP 的早产儿进行。在 NCPAP 戒断前和戒断后 3 小时进行肺部和膈肌超声检查。主要结局是评估肺部超声 (LUS) 在预测 NCPAP 成功脱机方面的准确性。结果 在 65 名入组早产儿中，30 名 (46.2%) 成功脱机 NCPAP 并改用室内空气。成功撤机组的胎龄较高，既往有创机械通气发生率较低，并且在试验撤机前对血流动力学显着的动脉导管未闭进行了治疗。在停止 NCPAP 之前测量的 LUS 评分≤6，成功脱机的预测灵敏度为 80%，特异性为 75%（曲线下面积 (AUC) = 0.865，≤.001）。当 NCPAP 脱机后 3 小时评估 LUS 评分时，≤7 的截止点预测成功脱机，敏感性和特异性分别为 90% 和 60%（AUC = 0.838，p≤ .001)。成功撤机组的膈肌厚度分数（DTF）显着降低。调整各种因素后，LUS评分仍然是成功撤机的唯一独立预测因素。结论NCPAP撤机前LUS评分对于预测早产儿NCPAP成功撤机具有良好的敏感性和特异性。膈肌偏移和 DTF 并不是很好的预测指标。