Chest
Clinical Investigations in Critical CareCough Peak Flows and Extubation Outcomes
Section snippets
Materials and Methods
The investigational review board of our hospital approved the study protocol. All patients in our medical-cardiac ICUs who were receiving mechanical ventilation via an endotracheal tube between June 2001 and December 2001 were eligible for the study. Patients were assessed when they had successfully completed an SBT and when extubation was about to be performed. In our ICU, weaning is guided by a nonmandatory protocol that is carried out by bedside nurses, respiratory therapists, and resident
Cohort Characteristics
There were 99 separate hospitalizations involving 95 patients who met eligibility criteria. These patients contributed a total of 115 separate extubations. Their ages ranged from 24 to 93 years (mean ± SE, 63.9 ± 1.7 years; Table 1). Forty-four percent of the patients were men. The patients varied in acuity of illness, with a range of ICU admission APACHE II scores of 4 to 42 (mean, 23.2 ± 0.8). The primary reasons for their ICU admissions and intubation were airway protection (for a variety of
Discussion
This study confirms that cough strength is a potent predictor of extubation outcomes in patients without primary neuromuscular disease who have passed an SBT. Also, the findings suggest that cough strength is a good predictor of in-hospital mortality in this population of critically ill patients. The study failed to find a statistically significant association between the quantity of suctioned secretions and outcomes.
The finding of an association between cough strength and extubation outcomes
ACKNOWLEDGMENT
The authors thank Joseph Horne, RRT, Bridgeport Hospital Pulmonary Function Laboratory, who assisted in calibrations of the peak flowmeters used in this study.
References (7)
Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physiciains; the American Association for Respiratory Care; and the American College of Critical Care Medicine
Chest
(2001)- et al.
Predictors of extubation outcome in patients who have passed a trial of spontaneous breathing
Chest
(2001) - et al.
Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure: a different approach to weaning
Chest
(1996)
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2023, Intensive and Critical Care NursingCitation Excerpt :Studies have shown that the patient's peak cough flow rate can be measured to determine whether the patient's coughing ability meets the criteria for successful extubation (Brennan et al., 2022). Smina's study (Smina et al., 2003) found that cough peak flow values were significantly lower in patients with failed extubation than in patients with successful extubation. In clinical practice, the patient's muscle weakness can be improved through pulmonary rehabilitation and early bed mobility to strengthen respiratory muscle function.
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2021, ChestCitation Excerpt :However, the baseline CPF values suggested for starting assisted cough techniques in young children may have to be lower than the adult-specific values.80 In adults, CPF has been measured before extubation as a predictor of reintubation.81-83 Patients with CPF < ∼360 L/min were found to be at high risk of reintubation for both inadequate voluntary82 and involuntary cough.84