RT Journal Article
SR Electronic
T1 Predicting extubation outcomes using Heart Rate Characteristics Index in Preterm Infants: A cohort study
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1901755
DO 10.1183/13993003.01755-2019
A1 Mallinath Chakraborty
A1 William John Watkins
A1 Katherine Tansey
A1 William E. King
A1 Sujoy Banerjee
YR 2020
UL http://erj.ersjournals.com/content/early/2020/05/19/13993003.01755-2019.abstract
AB A strategy of early extubation to non-invasive respiratory support in preterm infants could be boosted by the availability of a decision-support tool for clinicians. Using the Heart Rate Characteristics index (HRCi) with clinical parameters, we derived and validated predictive models for extubation readiness and success.Peri-extubation demographic, clinical and HRCi data for up to 96 h were collected from mechanically ventilated infants in the control arm of a randomised trial involving 8 neonatal centres, where clinicians were blinded to the HRCi scores. The data was used to produce a multivariable regression model for the probability of subsequent re-intubation. Additionally, a survival model was produced to estimate the probability of reintubation in the period after extubation.Of the 577 eligible infants, data from 397 infants (2/3rd) were used to derive the pre-extubation model and 180 infants for validation. The model was also fitted and validated using all combinations of training (5-centres) and test (3-centres) centres. The estimated probability for the validation episodes showed discrimination with high statistical significance, with the area under the curve of 0.72 (0.71, 0.74; p<0.001). Data from all infants were used to derive models of the predictive instantaneous hazard of re-intubation adjusted for clinical parameters.Predictive models of extubation readiness and success in real-time can be derived using physiological and clinical variables. The models from our analyses can be accessed using an online tool at www.heroscore.com/extubation/ and have the potential to inform and supplement the confidence of the clinician considering extubation in preterm infants.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Chakraborty has nothing to disclose.Conflict of interest: Dr. Watkins has nothing to disclose.Conflict of interest: Dr. Tansey has nothing to disclose.Conflict of interest: Mr. King reports personal fees from MPSC, outside the submitted work;.Conflict of interest: Dr. Banerjee has nothing to disclose.