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Related Experiment Videos

Cough peak flows and extubation outcomes.

Mihai Smina1, Adil Salam, Mohammad Khamiees

  • 1Pulmonary and Critical Care, Bridgeport Hospital and Yale University School of Medicine, Bridgeport, CT 06610, USA.

Chest
|July 11, 2003
PubMed
Summary

Objective cough strength, measured by peak expiratory flow (PEF), predicts extubation success in critically ill patients. Lower PEF is linked to higher rates of failed extubation and mortality.

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Area of Science:

  • Critical Care Medicine
  • Pulmonary Medicine
  • Respiratory Therapy

Background:

  • Semiobjective methods for quantifying cough strength and endotracheal secretions can predict extubation outcomes in patients who have passed a spontaneous breathing trial (SBT).
  • Volumetric measurement of secretions and voluntary cough peak expiratory flow (PEF) are key indicators.

Purpose of the Study:

  • To evaluate the predictive value of cough strength (PEF) and endotracheal secretions for extubation outcomes in critically ill patients.
  • To determine the association of PEF with extubation success, morbidity, and mortality.

Main Methods:

  • A study was conducted on critically ill patients in a medical ICU who passed an SBT and were candidates for extubation.
  • Cough strength (best of three attempts, measured by spirometer) and hourly suctioned secretions were recorded.

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  • Demographic data, duration of intubation, and APACHE II scores were collected for analysis.

    • Main Results:

    • Ninety-five patients underwent 115 extubations, with 13 unsuccessful attempts.
    • No significant differences in age, gender, intubation duration, or APACHE II scores were found between successful and unsuccessful extubations.
    • Lower PEF (< 60 L/min) was significantly associated with unsuccessful extubations (p=0.03), longer ICU stays (p=0.009), and increased in-hospital mortality (odds ratio=19).
    • Endotracheal secretions did not correlate with outcomes.

    Conclusions:

    • Objective measurement of cough strength via PEF is a valuable predictor of extubation outcomes.
    • PEF is independently associated with extubation success, morbidity, and in-hospital mortality.
    • This finding supports the use of cough strength assessment in weaning protocols.