Interest of an objective evaluation of cough during weaning from mechanical ventilation.
OBJECTIVE
This study aimed to evaluate an objective measure of cough strength, the peak cough expiratory flow (PCEF), as a predictive criterion of success or failure of extubation.


METHODS
Patients under mechanical ventilation for more than 24 h who successfully passed the spontaneous breathing trial were included in the study. Just before extubation, PCEF was measured with an electronic flowmeter.


RESULTS
A total of 130 patients were included. The median duration of mechanical ventilation before extubation was 8 days (4-17). Fourteen patients (10.8%) failed extubation. The sole factor significantly associated with extubation failure was the measure of PCEF. The patients who did not cough at order had a higher rate of extubation failure than those who did (P = 0.03). The mean PCEF of patients who failed extubation (36.3 +/- 15 l/min) was significantly lower than the one of patients who succeeded (63.6 +/- 32 l/min) (P < 0.001). The optimal cut-off value of PCEF was 35 l/min. Overall, an inability to cough at order or a PCEF < or =35 l/min predicted extubation failure with a sensitivity of 79% and a specificity of 71%. The risk of extubation failure was 24% for the patients who did not cough at order or with a PCEF < or =35 l/min and 3.5% for those with a PCEF >35 l/min [RR = 6.9 (95% CI, 2-24); P = 0.002].


CONCLUSIONS
This study confirmed the interest of measuring the PCEF to predict extubation outcome in patients having successfully passed the spontaneous breathing trial.
Beuret
Pascal
P
Intensive Care Unit, Centre Hospitalier Roanne, 28 rue de Charlieu, 42328 Roanne, France. pascal.beuret@ch-roanne.fr
Roux
Christophe
C
Auclair
Annie
A
Nourdine
Karim
K
Kaaki
Mahmoud
M
Carton
Marie-Jose
MJ
D000368:Aged; D003371:Cough; D005260:Female; D005540:Forced Expiratory Flow Rates / Q000502:physiology; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D015300:Ventilator Weaning / Q000592:standards*