Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis

Lengthy mechanical ventilation in premature infants can lead to adverse consequences, like bronchopulmonary dysplasia, pneumonia, impaired neuronal development etc. Furthermore, extubation failure can heighten the probability of death; extend the duration of hospital stay, and a necessity for supplementary oxygen. 

Thus ventilator support must be withdrawn at an optimal time, which is still not clear. Clinical judgment by utilizing various strategies like spontaneous breathing trial (SBT) can aid in determining the ideal time to extubate, lessen the duration of mechanical ventilation and heighten the chances of success.

The SBT, a test of readiness test, assesses a patient's ability to breathe spontaneously with minimal or no support.

Although SBTs are advocated to be practiced in many neonatal ICUs, it is hardly reported. A recent study explored the literature to determine the accuracy of SBTs in predicting extubation failure in premature infants.

• 6 studies meeting the inclusion criteria were included for the analysis. 
• Endotracheal CPAP was performed with every SBT, utilizing a complete observation time of 3-5 min. 
• 5 studies had similar criteria for passing/failing the test (bradycardia/desaturation during the test). 
• Pooled sensitivity of SBT was found to be high signifying accurate recognition of neonates "prepared" for successful extubation. 
• Pooled specificity of SBT was found to be low suggesting an inaccurate forecast of extubation failure. 
• The heterogeneity of analyzed studies made it notable for sensitivity and significant for specificity.

Thus, extubation success but not extubation failure can be accurately anticipated by utilizing SBT in premature infants. Despite being attractive, practical, and easy-to-perform bedside assessment tools, the lack of evidence to support its use restricts its use as an independent predictor of extubation failure in premature infants. It must be carefully evaluated and monitored when used in a routine.

Teixeira RF, Carvalho ACA, de Araujo RD, Veloso FCS, Kassar SB, Medeiros AMC. Spontaneous Breathing Trials in Preterm Infants: Systematic Review and Meta-Analysis. Respir Care. 2021 Jan;66(1):129-137. doi: 10.4187/respcare.07928. Epub 2020 Aug 25. PMID: 32843509.