P3.J200: Use of Near Infrared Spectroscopy to Predict Extubation Outcomes in Children: A Meta-analysis of 734 Patients

Background: Extubation of pediatric patients following invasive mechanical ventilation may correlate with high failure and reintubation rates. Reliable predictors for extubation readiness are needed to reduce morbidity and mortality related to extubation failure in this population. Near Infrared Spectroscopy (NIRS) has become a valuable monitoring tool in Pediatric Intensive Care Units (PICUs) due to its cost-effective and non-invasive nature. Recent studies have highlighted the potential use of NIRS in predicting extubation failure and success. This meta-analysis represents the first comprehensive assessment of NIRS efficacy in determining extubation outcomes within this pediatric population.

Methods: A database search was conducted until March 4th, 2024. We identified studies evaluating pediatric patients in the PICU undergoing mechanical ventilation weaning. Our variables of interest considered cerebral, renal, or somatic NIRS before and after extubation to predict extubation readiness, or need for reintubation. Continuous numerical variables were assessed using mean difference (MD).

Results: Out of 441 articles, 4 retrospective, and 1 prospective cohort met our inclusion criteria. We added a total patient population of 734 patients, with a median age ranging from 6.5 days to 26 months. Our analysis showed significant differences in the renal change values (ΔRrSO2) between pre-extubation and post-extubation NIRS (MD= 9.71[95% CI 1.68-17.74], p=0.02). See Figure 1. Patients who experienced extubation failure exhibited a significant cerebral NIRS (ΔCrSO2) decrease from baseline when compared to successfully-extubated patients (MD=5.83[95% CI 1.49-10.17], p=0.009). Referred to figure 2. Notably, the baseline pre-extubation NIRS measurements in our sample before extubation are similar among groups, specifically, we identified a renal-NIRS MD of -9.21 (95% CI -41.92-23.50, p=0.58) and a cerebral-NIRS MD of 3.13 (95% CI -1.42-7.69, p=0.18).

Conclusion: Our analysis suggests that NIRS can effectively correlate with and assess extubation readiness in children. Our findings are representative of the renal and cerebral changes from baseline to post-extubation NIRS. These results favor the potential use of NIRS as a prognostic, cost-effective tool to predict extubation success. Additionally, NIRS may aid clinicians in guiding the need for reintubation in the ICU. While valuable, this study highlights the need for randomized controlled trials to confirm these preliminary findings and to enhance our understanding of the correlation between cerebral and renal NIRS.