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Interest of an objective evaluation of cough during weaning from mechanical ventilation

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Abstract

Purpose

This study aimed to evaluate an objective measure of cough strength, the peak cough expiratory flow (PCEF), as a predictive criterion of success or failure of extubation.

Methods

Patients under mechanical ventilation for more than 24 h who successfully passed the spontaneous breathing trial were included in the study. Just before extubation, PCEF was measured with an electronic flowmeter.

Results

A total of 130 patients were included. The median duration of mechanical ventilation before extubation was 8 days (4–17). Fourteen patients (10.8%) failed extubation. The sole factor significantly associated with extubation failure was the measure of PCEF. The patients who did not cough at order had a higher rate of extubation failure than those who did (P = 0.03). The mean PCEF of patients who failed extubation (36.3 ± 15 l/min) was significantly lower than the one of patients who succeeded (63.6 ± 32 l/min) (P < 0.001). The optimal cut-off value of PCEF was 35 l/min. Overall, an inability to cough at order or a PCEF ≤35 l/min predicted extubation failure with a sensitivity of 79% and a specificity of 71%. The risk of extubation failure was 24% for the patients who did not cough at order or with a PCEF ≤35 l/min and 3.5% for those with a PCEF >35 l/min [RR = 6.9 (95% CI, 2–24); P = 0.002].

Conclusions

This study confirmed the interest of measuring the PCEF to predict extubation outcome in patients having successfully passed the spontaneous breathing trial.

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Authors and Affiliations

  1. Intensive Care Unit, Centre Hospitalier Roanne, 28 rue de Charlieu, 42328, Roanne, France

    Pascal Beuret, Christophe Roux, Annie Auclair, Karim Nourdine, Mahmoud Kaaki & Marie-Jose Carton

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  1. Pascal Beuret
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  2. Christophe Roux
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  3. Annie Auclair
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  4. Karim Nourdine
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  5. Mahmoud Kaaki
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  6. Marie-Jose Carton
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Correspondence to Pascal Beuret.

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Beuret, P., Roux, C., Auclair, A. et al. Interest of an objective evaluation of cough during weaning from mechanical ventilation. Intensive Care Med 35, 1090–1093 (2009). https://doi.org/10.1007/s00134-009-1404-9

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  • DOI: https://doi.org/10.1007/s00134-009-1404-9

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