Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects.
BACKGROUND: In this study, we compared the predictive accuracy of voluntary cough peak flow (V-CPF) and involuntary cough peak flow (IV-CPF) for re-intubation in mechanically ventilated subjects. METHODS: Endotracheally intubated patients who passed a spontaneous breathing trial and assessment of re...
| Publicado en: | Respiratory Care Vol. 59; no. 11; pp. 1643 - 1652 |
|---|---|
| Autores principales: | , , , , , |
| Formato: | pictorial research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Nov2014
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=103777224&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 103777224 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Nov2014 vid: 59 iid: 11 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 103777224 99111421 10.4187/respcare.03045 NLM25140034 103777224 ppf: 1643 ppct: 9 formats: fmt: @attributes: type: P tig: atl: Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects. aug: au: Jun Duan Jinhua Liu Meiling Xiao Xiangmei Yang Jinxing Wu Lintong Zhou affil: Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China sug: subj: Tracheostomy Respiration, Artificial Intubation, Intratracheal Extubation Cough Risk Assessment Methods Noninvasive Procedures Human Funding Source Female Male Aged Aged, 80 and Over Middle Age Education, Continuing (Credit) Descriptive Statistics ROC Curve Academic Medical Centers Data Analysis Software Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Female Male ab: BACKGROUND: In this study, we compared the predictive accuracy of voluntary cough peak flow (V-CPF) and involuntary cough peak flow (IV-CPF) for re-intubation in mechanically ventilated subjects. METHODS: Endotracheally intubated patients who passed a spontaneous breathing trial and assessment of readiness for extubation were enrolled. Before extubation, V-CPF and IV-CPF were measured. Re-intubation was recorded at 72 h after extubation. RESULTS: A total of 115 extubations in 106 cooperative subjects (including 9 subjects with second extubation) and 5 extubations in 5 uncooperative subjects were recorded. At 72 h, 20 (17.4%) and 1 (25%) instances of re-intubation occurred in cooperative and uncooperative subjects, respectively. In cooperative subjects, those who had been successfully extubated had higher V-CPF than re-intubated subjects (81.3 ± 41.4 vs 51.3 ± 31.7, P = .003). However, rates were not significantly different with IV-CPF (70.9 ± 39.8 vs 55.7 ± 37.9, P = .121). Areas under the curve of the receiver operating characteristic in V-CPF and IV-CPF were 0.743 ± 0.057 and 0.632 ± 0.069 (P < .001 and P = .058, respectively, compared with area under the curve = 0.5). V-CPF had higher predictive accuracy for re-intubation than IV-CPF (P = .034). In subjects with a lower quartile and third quartile V-CPF (≤ 43.2 L/min and 43.2– 68.4 L/min, respectively), V-CPF was similar to IV-CPF. However, in second quartile and upper quartile V-CPF (68.4 –99.0 L/min and > 99.0 L/min, respectively), V-CPF was higher than IV-CPF (82.1 ± 9.6 vs 66.6 ± 19.5 L/min, P < .001; 135.5 ± 29.8 vs 116.2 ± 38.2 L/min, P = .006, respectively). Overall, V-CPF was higher than IV-CPF (76.0 ± 41.4 vs 68.2 ± 39.7, P = .003). In uncooperative subjects, the IV-CPF was higher than V-CPF (40.2 ± 10.2 vs 79.2 ± 29.0, P = .042). CONCLUSIONS: V-CPF is noninvasive. It is much more accurate than IV-CPF as a predictor of re-intubation in cooperative patients because the IV-CPF may underestimate cough strength in patients with high V-CPF. However, it is unclear which is optimal for use in uncooperative patients. pubtype: Academic Journal doctype: pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|