Accuracy of lung ultrasound in predicting extubation failure in neonates: A systematic review and meta‐analysis

• Published in: Pediatric pulmonology 2023-10, Vol.58 (10), p.2846-2856
• Main Authors: Mohsen, Nada, Solis‐Garcia, Gonzalo, Jasani, Bonny, Nasef, Nehad, Mohamed, Adel
• Format: Article
• Language: English
• Subjects: Accuracy; diagnostic accuracy; Extubation; lung ultrasound; Meta-analysis; neonates; Ultrasonic imaging
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.26598

Objective To systematically review and meta‐analyze the diagnostic accuracy of lung ultrasound score (LUS) in predicting extubation failure in neonates. Study Design MEDLINE, COCHRANE, EMBASE, CINAHL, and clinicaltrials.gov were searched up to 30 November 2022, for studies evaluating the diagnostic accuracy of LUS in predicting extubation outcome in mechanically ventilated neonates. Methodology Two investigators independently assessed study eligibility, extracted data, and assessed study quality using the Quality Assessment for Studies of Diagnostic Accuracy 2 tool. We conducted a meta‐analysis of pooled diagnostic accuracy data using random‐effect models. Data were reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. We calculated pooled sensitivity and specificity, pooled diagnostic odds ratios with 95% confidence intervals (CI), and area under the curve (AUC). Results Eight observational studies involving 564 neonates were included, and the risk of bias was low in seven studies. The pooled sensitivity and specificity for LUS in predicting extubation failure in neonates were 0.82 (95% CI: 0.75−0.88) and 0.83 (95% CI: 0.78−0.86), respectively. The pooled diagnostic odds ratio was 21.24 (95% CI: 10.45−43.19), and the AUC for LUS predicting extubation failure was 0.87 (95% CI: 0.80−0.95). Heterogeneity among included studies was low, both graphically and by statistical criteria (I2 = 7.35%, p = 0.37). Conclusions The predictive value of LUS in neonatal extubation failure may hold promise. However, given the current level of evidence and the methodological heterogeneity observed, there is a clear need for large‐scale, well‐designed prospective studies that establish standardized protocols for lung ultrasound performance and scoring. Registration The protocol was registered in OSF (https://doi.org/10.17605/OSF.IO/ZXQUT).