Changes in Pulmonary Function After A Caffeine Loading Dose and Extubation Outcome in Preterm Infants with Respiratory Distress Syndrome
Bibliographic record
Abstract
Abstract BACKGROUND: Prolonged endotracheal intubation in preterm infants leads to adverse outcomes including bronchopulmonary dysplasia, pneumonia and sepsis. Extubating preterm infants early can lead to apneas, respiratory distress and hypoxemia with reintubation, a destabilizing and traumatic event. Identifying readiness for extubation would avoid these harmful events. Current clinical criteria perform poorly in predicting extu-bation outcome in preterm infants. Caffeine is used to facilitate extubation and also affects pulmonary function. OBJECTIVES: To determine pulmonary functions before and after a caffeine loading dose in preterm infants < 31 weeks gestation with respiratory distress syndrome (RDS) undergoing their first trial of extubation and use them to predict extubation outcome. DESIGN/METHODS: We determined dynamic compliance (Cdyn), tidal volume (TV), minute ventilation (MV), and dynamic airway resistance (Rdyn) before and after a loading dose of 10 mg/kg of caffeine base in preterm infants <31 weeks gestation with RDS prior to extubation. These measurements were taken as an average of ten non-distorted breaths with < 10% endotracheal air leak. Infants were ventilated with the EvitaXl Neo (Draeger, Germany). Pulmonary function readings were downloaded from the ventilator. Extubation failure was defined as the need for reintubation within 72 h after extubation. Exclusion criteria included grade 3-4 intra-ventricular hemorrhage, sedation, pneumothorax, medications affecting pulmonary function, chromosomal and congenital malformations. Mann Whitney test was used for continuous variables and the χ2 or Fisher’s exact test for dichotomous data. A p value <0.05 was considered significant. RESULTS: Blood gas values and ventilator parameters were similar between the groups before extubation.There was significant improvement in pulmonary function after a loading dose caffeine. Amongst pulmonary functions, ratio of Cdyn before and after caffeine performed best in predicting extubation outcome with an area under the curve of 0.85 (95% CI 0.79-0.94). CONCLUSION: Caffeine improves pulmonary function in preterm infants. A ratio of dynamic compliance before and after caffeine best predicted extu-bation outcome. Our results need validation in a prospective study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".