title: Heart rate variability and extubation readiness in extremely preterm infants.
abstract: BACKGROUND
  Mechanical ventilation (MV) is associated with changes in autonomic nervous system activity in preterm infants, which can be assessed by measurements of heart rate variability (HRV). Decreased HRV has been described in adults undergoing disconnection from MV; such information is not available in preterm infants.
  
  
  OBJECTIVE
  To compare differences in HRV between infants successfully extubated and those who failed, and to evaluate the accuracy of HRV as a predictor of extubation readiness.
  
  
  METHODS
  This is a prospective, observational study of infants with a birth weight ≤1,250 g undergoing their first extubation attempt. Heart rate was measured during a 60-min period immediately prior to extubation and HRV was calculated using the frequency domain analysis.
  
  
  RESULTS
  A total of 47 infants were studied; 36 were successfully extubated and 11 reintubated. There were no differences in patient demographics, ventilator settings, blood gases or postextubation management between the groups. All components of the HRV analysis were significantly decreased in infants who failed, generating high areas under the receiver operating characteristic curve. The specificity and positive predictive values were 100, but with limited sensitivity and negative predictive values.
  
  
  CONCLUSIONS
  Infants considered 'ready to be extubated' but who subsequently failed their first extubation attempt had decreased HRV prior to extubation. Though promising, the value of HRV as a predictor of extubation readiness requires further evaluation.
authors.affiliation: Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Que., Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kaczmarek
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chawla
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marchica
authors.forename: Meghan
authors.initials: M
authors.lastname: Dwaihy
authors.forename: Linda
authors.initials: L
authors.lastname: Grundy
authors.forename: Guilherme Mendes
authors.initials: GM
authors.lastname: Sant'Anna
mesh_terms: D060666:Airway Extubation; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D062071:Infant, Extremely Premature / Q000502:physiology*; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal; D007442:Intubation, Intratracheal; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D015300:Ventilator Weaning