Cough peak flow to predict the extubation outcome: Comparison between three cough stimulation methods

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Pulmonary Rehabilitation

Background:

• Predicting extubation success is crucial for managing mechanically ventilated patients.
• Cough peak flow (CPF) is a potential indicator of airway clearance and extubation readiness.
• Various methods exist to stimulate and measure CPF, but their comparative accuracy is not well-established.

Purpose of the Study:

• To compare the predictive accuracy of three distinct cough peak flow (CPF) measurement techniques in determining extubation outcomes.
• To evaluate voluntary command (V_CPF), saline-instilled (S_CPF), and catheter-stimulated (C_CPF) maneuvers for predicting extubation success.
• To assess the accuracy of post-extubation CPF (PE_CPF) in predicting extubation outcomes.

Main Methods:

• Eighty-one mechanically ventilated patients who passed a spontaneous breathing trial were enrolled.
• CPF was measured using V_CPF, S_CPF, and C_CPF in a randomized sequence.
• Receiver operating characteristic (ROC) curves were used to determine diagnostic accuracy, with results compared using the Hanley and McNeil method.

Main Results:

• All three CPF methods demonstrated high predictive accuracy: V_CPF (0.89), S_CPF (0.93), and C_CPF (0.90).
• No statistically significant differences were found between the accuracies of the three CPF measurement techniques.
• Post-extubation CPF (PE_CPF) also showed high accuracy (AUC = 0.95) with an optimal cutoff of 75 L/min.

Conclusions:

• In cooperative, mechanically ventilated patients, V_CPF, S_CPF, and C_CPF exhibit comparable accuracy in predicting extubation success.
• CPF measurement after endotracheal tube removal is a highly accurate predictor of extubation outcomes.
• These findings support the use of CPF as a valuable tool in weaning and extubation protocols.