• Raphaela Farias Teixeira, CarvalhoAline Carla AraújoACACESMAC University Centre, Maceió, Alagoas, Brazil.State University of Health Sciences of Alagoas, Maceió, Alagoas, Brazil., Rosana Danielly de Araujo, Felipe Camilo Santiago Veloso, Samir Buainain Kassar, and Andrea Monteiro Correia Medeiros.
• Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil. ftraphaelafarias@hotmail.com.
• Respir Care. 2021 Jan 1; 66 (1): 129137129-137.

BackgroundFew data are available on the use of spontaneous breathing trials (SBTs) in the neonatal population, despite advocacy of the practice in many neonatal ICUs. In this meta-analysis, we systematically reviewed the literature regarding the accuracy of SBTs as a predictor for extubation failure in premature infants.MethodsFollowing the PRISMA recommendations, scientific articles were collected in December 2019 and January 2020 using PubMed, LILACS, Web of Science, Scopus, Google Scholar, OATD, and BDTD databases. The risk of bias in the studies included herein was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity and specificity of the studies were estimated using a mixed logistic regression model of 2 levels and a normal bivariate model.ResultsSix studies were included for qualitative and quantitative evaluation in this study. All SBTs were performed with endotracheal CPAP, with a total observation time of 3-5 min. The parameters for passing/failing the test were similar in 5 of the 6 studies and included bradycardia or desaturation during the test. The SBT showed a high pooled sensitivity (0.97, 95% CI 0.85-0.99), indicating proper identification of neonates "ready" for successful extubation. However, a low pooled specificity (0.40, 95% CI 0.24-0.58), with many false-positive cases, indicated inaccurate prediction of extubation failure. Heterogeneity of included studies was considerable for sensitivity and substantial for specificity.ConclusionsThe SBT in premature infants can accurately predict extubation success but not extubation failure. Therefore, even though it is an attractive, practical, and easy-to-perform bedside assessment tool, there is a lack of evidence to support its use as an independent predictor of extubation failure in premature infants. Its routine use should be evaluated and monitored carefully.Copyright © 2021 by Daedalus Enterprises.

15 keywords...

hide…