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Assessment of cough peak flow (CPF) is frequently utilized to determine the need for cough augmentation. CPF < 270 L/min is the established standard for implementing assisted coughing techniques in patients with neuromuscular disease (NMD).1 Whereas the indications during invasive mechanical ventilation are not as well defined, CPF < 60 L/min along with signs of secretion retention have been used to initiate therapy in this patient population.2,3
CPF has also been utilized to assess effectiveness of cough augmentation. Measurements can be obtained through a variety of methods including a spirometer, peak flow meter, mechanical insufflation-exsufflation (MI-E) devices, and ventilators. In the early 1990s, Bach4 compared CPF obtained with a peak flow meter during assisted and unassisted coughing in adults with NMD and found that assisted techniques including MI-E significantly increased CPF. An evaluation comparing CPF measured with a spirometer and with a peak flow meter did not identify significant differences between the devices; however, the peak flow meter may underestimate CPF.5
Cough strength during mechanical ventilation has been associated with extubation outcomes, as a weak cough effort has been linked to increased rates of re-intubation.6,7 Low-level evidence has suggested use of MI-E during invasive ventilation may reduce extubation failure.8 Gobert9 and others measured CPF using an ICU ventilator to construct a composite score for predicting extubation failure. A different …
Correspondence: L Denise Willis MSc RRT RRT-NPS AE-C FAARC, 1 Children’s Way, Slot 303, Little Rock, AR 72202. E-mail: WillisLD{at}archildrens.org
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