Abstract :
Keywords Neonates; NICOM; Cardiac output; Extubation; PDA Highlights * Non-invasive cardiac output monitoring measures cardiac output trend in neonates. * Peri-extubation non-invasive cardiac output monitoring is feasible in neonates. * Elective extubation causes significant changes in cardiac output in neonates. * Patent ductus arteriosus status appears to alter this change. Abstract Background Mechanical ventilation induces changes in intrapleural, intrathoracic and intra-abdominal pressure. These changes have various implications on cardiac output (CO). Aims The aim of this study was to determine the feasibility of measuring changes in CO after elective extubation in neonates using the principle of transthoracic bioreactance (TBR). Study design This was a prospective observational cohort study in a level III neonatal centre. CO, stroke volume (SV) and heart rate were measured continuously for 2 h before and 2 h after elective extubation by TBR. Subjects Neonates undergoing elective extubation were eligible for enrolment. Outcome measures The primary outcome of the study was change in CO post elective extubation. Results Ten neonates were enrolled, seven (70 %) had a statistically significant decrease in CO after extubation, three (30 %) infants had a statistically significant increase in CO after extubation. Changes in CO were primarily driven by changes in SV and the pattern of change was related to patent ductus arteriosus (PDA) status prior to extubation. Conclusion Extubation significantly influences CO in neonatal patients and the pattern of change appears to be related to PDA status. Abbreviations CO, cardiac output; ELBW, extremely low birth weight; EV, electric velocimetry; FiO.sub.2, fraction of inspired oxygen; HR, heart rate; hs, haemodynamically significant; LV, left ventricular; LVO, left ventricular output; MAP, mean airway pressure; NCPAP, nasal continuous positive airway pressure; NICOM, non-invasive cardiac output monitoring; NIPPV, nasal intermittent positive pressure ventilation; NPE, neonatologist performed echocardiography; NRS, no respiratory support; PDA, patent ductus arteriosus; PEEP, positive end-expiratory pressure; SD, standard deviation; SV, stroke volume; TBR, transthoracic bioreactance Author Affiliation: (a) Coombe Women and Infants University Hospital, Dublin, Ireland (b) Institute for the Care of Mother and Child, Prague, Czech Republic (c) UCD School of Medicine, University College Dublin, Dublin, Ireland (d) 3rd Faculty of Medicine, Charles University, Prague, Czech Republic * Corresponding author. Article History: Received 26 January 2022; Revised 6 June 2022; Accepted 9 June 2022 Byline: Mullaly Rachel [mullalyr@tcd.ie] (a,*), Miletin Jan (a,b,c,d), Cary Heather (a), Semberova Jana [jsemberova@coombe.ie] (a,b,c)