The relationship between cough peak flow and extubation outcome in patients with acute brain injury: A retrospective...

Cough ability is crucial for extubation in mechanically ventilated acute brain injury (ABI) patients. Cough peak flow (CPF) assesses coughing ability. This study investigates its relationship with extubation outcomes.

A retrospective cohort study from April 2020 to April 2023 in an intensive care unit ward included mechanically ventilated adult ABI patients on ventilation for at least 24 h. ABI patients were divided by CPF (<60 L/min and ≥60 L/min). Outcomes included extubation success, ventilation days, pneumonia rate, tracheostomy rate, intensive care unit mortality, and length of stay. Multivariable logistic regression analyzed CPF-association with extubation, and receiver operating characteristic curve determined the optimal cutoff.

There were 240 ABI patients included. In the CPF <60L/min group (29 patients), extubation failure after spontaneous breathing trial was 44.8%, median mechanical ventilation time was 3 days, tracheostomy rate was 10.3%, and ventilator-associated pneumonia rate was 20.7%. In the CPF≥60L/min group (211 patients), these were 8.5%, 1 day, 1.4%, and 3.3%, respectively. CPF was significantly associated with extubation failure (adjusted odds ratio: 0.94; 95% confidence intervals (CI): 0.92-0.96; p<0.001). The risk of extubation failure in the group with CPF<60 L/min was 5 times higher than that in the group with CPF≥60 L/min (adjusted odds ratio: 5.0; 95% CI: 2.32-11.11; p<0.001). Receiver operating characteristic analysis identified an optimal cutoff of 68.5 L/min (area under curve=0.829, 95% CI: 0.742-0.916).

CPF is significantly associated with extubation outcome in ABI patients with a successful spontaneous breathing trial.