Non-invasive cardiac output monitoring before and after baby extubation – A feasibility study (NICOMBabe study)

Mechanical ventilation induces changes in intrapleural, intrathoracic and intra-abdominal pressure. These changes have various implications on cardiac output (CO). 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). 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. Neonates undergoing elective extubation were eligible for enrolment. The primary outcome of the study was change in CO post elective extubation. 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. Extubation significantly influences CO in neonatal patients and the pattern of change appears to be related to PDA status.