الفهرس 
WEANING from MECHANICAL VENTILATIONOnly 14 pages are availabe for public view
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Abstract
t
iming is crucial when deciding whether a patient can be successfully weaned from MV or not. As both premature extubation and unnecessary delay have been associated with poor outcome (Soliman et al., 2018).
Daily monitoring of mechanically ventilated neonates is recommended to ensure adequate oxygenation, ventilation and airway reflexes. In spite of all methods done, still one-third of neonates fail to be weaned due to absent enough guidelines for assessment of readiness to extubation(Shalish et al., 2018).
Loss of lung aeration and cardiac factors as lung congestion or heart failure are known participating factors in extubation faliure. so, their evaluation is recommended before the neonatal weaning from MV (Caille et al., 2010).
The degree of loss of lung aeration in different respiratory conditions can be diagnosed and quantified by LUS score (Ma et al., 2020).
Thoracic fluid content (TFC) measured by non invasive electrical cardiometry is defined as the whole fluid volume in the thorax. So, it represents an indirect measure of lung congestion and used to estimate fluid volume changes in the thorax (Fathy et al., 2020).
The main aim of this study was to assess the accuracy of TFC measured by noninvasive electrical cardiometry as a predictor of successful weaning compared to lung ultrasound in neonates.
We recruited 62 neonates who were divided according to their GA into two equal groups group(1) with GA less than or equal 34 weeks and group(2) with GA more than 34 weeks.
Group(1) had significantly lower GA and birth weight on initiation of ventilation and prior to extubation.
On initiation of MV, group (1) had lower postnatal age on initiation of ventilation. They also had higher respiratory rates and Downes’ score than the other group.
When comparing both groups regarding the duration of ventilation. we found that group(1) spent significantly longer duration on ventilation when compared to the other group.
Lower oxygen saturation was found in group (1) compared to group (2).
Significantly higher ventilatory settings were in group (1) compared to group (2) with older age on initiation of MV and before extubation.
The enrolled neonates were furtherly classified according to their extubation outcome into two groups successfully weaned group (group S) included 44 neonates (71%) and failed weaned group (group F) included 18 neonates (29%).
When comparing both groups we found significantly higher GA and birth weight in group S than group F.
Concerning postnatal age on initiation of invasive MV and total duration of MV, group F had significantly lower postnatal age on initiation of invasive MV and longer total duration of MV than group S.
There was no difference between the two groups as regards gender, initial diagnosis and age on admission in NICU.
Our success group (group S) had statistically significant lower respiratory rates (RR) and Downes’ scores than group F before initiation of ventilation and prior to extubation.
Laboratory results (CBC and CRP) were comparable in both groups (S & F) on admission and prior to extubation.
Our study showed no difference between the two groups as regards ABG assessed on initiation of invasive MV and prior to extubation.
In our group F oxygen saturation levels were significantly lower than group S on admission but, prior to extubation both groups were comparable.
Regarding ventilatory settings on initiation of MV and prior to extubation, they were Significantly higher in group F than group S.
We found a positive correlation between LUS score and TFC. Neonates with higher LUS scores tended to have higher TFCs.
LUS and TFC were significantly lower in group S on initiation of MV and prior to extubation indicating that they can be used as good indicators for predicting successful weaning from MV in neonates.
To test the validity of LUS score prior to extubation for prediction of successful weaning, ROC curve was analysed. the best cut off value for LUS scores was < 5 with Sensitivity 73.13% and specificity 63.13.
ROC curve analysis was performed to test the validity of TFC for prediction of successful weaning. the best cut off value for TFC was< 41. 51 kΩ−1 with sensitivity 75.30 % and specificity 81.3%.