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Value of routine postextubation chest X-ray on prognosis for neonates
J L Alvarado-Socarrás1, F A Diaz-Quijano
1Colombia Cardiovascular Foundation Floridablanca, Colombia:2 Organización Latinoamericana para el Fomento de la Investigación en Salud (OLFIS), Bucaramanga, Colombia - jorgealso2@yahoo.com.
Insights
Routine post-extubation chest X-rays (CXRs) in neonates after mechanical ventilation (MV) may speed up hospital discharge but their overall prognostic utility is uncertain. Further large-scale studies are needed to determine the relevance of this practice.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Radiology
Background:
- Postextubation chest X-rays (CXRs) are commonly performed in neonates following mechanical ventilation (MV).
- This practice lacks strong evidence supporting its routine use and impact on patient outcomes.
- Assessing the utility of routine CXRs is crucial for optimizing neonatal care protocols.
Purpose of the Study:
- To evaluate the clinical utility of routine postextubation chest X-rays (CXRs) in neonates who have undergone mechanical ventilation (MV).
- To determine if routine CXRs influence patient prognosis, including reintubation rates, hospital stay, and mortality.
- To compare outcomes between routine and selective postextubation CXR strategies.
Main Methods:
- Retrospective cohort study comparing two time periods with different CXR protocols.
- Period 1: Routine postextubation CXR for all neonates post-MV.
- Period 2: Selective postextubation CXR only for neonates with clinical deterioration; continuous follow-up for complications.
Main Results:
- No significant difference in reintubation rates or mortality between routine and selective CXR groups.
- Routine CXR was associated with accelerated hospital discharge (Hazard Ratio: 1.86).
- Birth weight, nasal CPAP, and duration of MV were significant predictors of hospital stay post-extubation.
Conclusions:
- The utility of routine postextubation chest X-rays (CXRs) in neonates after mechanical ventilation (MV) for improving prognosis remains uncertain.
- While routine CXRs may expedite hospital discharge, their overall impact on critical outcomes requires further investigation.
- Larger, high-magnitude studies are necessary to definitively assess the relevance and benefit of routine postextubation CXRs.
Aim:
The postextubation chest X-ray (CXR) is frequently taken in neonates who have undergone mechanical ventilation (MV); however, this is not an evidence-based practice. The aim of this paper was to assess the utility of routine post-extubation CXR on the prognosis for neonates who have undergone MV.
Methods:
This is a retrospective cohort study comparing two periods of time. During the first period, the routine postextubation CXR was performed in neonates; during the second period, postextubation CXR was performed only in infants with any sign of clinical deterioration. Patients were continuously followed up to identify complications such as need for reintubation, length of hospital stay, and death.
Results:
Twenty-nine vs. 33 patients were compared in the first and second periods, respectively. Throughout follow-up one patient died (in the routine CXR period) and there were 17 reintubations: 8 in the routine CXR group and 9 in the selective CXR group (P=1). However, in a multivariate Cox model (adjusted for birth weight, nasal continuous positive airway pressure [CPAP], bronchopulmonary dysplasia and duration of MV), the routine CXR was associated with an acceleration of discharge after extubation (Hazard Ratio: 1.86, 95% CI: 1.02-3.38). On the other hand, birthweight, nasal-CPAP and duration of MV were strong predictors of hospital stay after extubation.
Conclusion:
Although it may help accelerate hospital discharge, the utility of routine CXR on prognosis is uncertain. Consequently, it is required to conduct studies of greater magnitude in order to assess the relevance of this procedure.
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