title: Reflex cough PEF as a predictor of successful extubation in neurological patients.
abstract: OBJECTIVE
  To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation.
  
  
  METHODS
  This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters.
  
  
  RESULTS
  The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure.
  
  
  CONCLUSIONS
  Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.
authors.affiliation: Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, BR.
authors.forename: Fernanda Machado
authors.initials: FM
authors.lastname: Kutchak
authors.affiliation: Hospital Cristo Redentor, Porto Alegre, RS, BR.
authors.forename: Andressa Maciel
authors.initials: AM
authors.lastname: Debesaitys
authors.affiliation: Hospital Cristo Redentor, Porto Alegre, RS, BR.
authors.forename: Marcelo de Mello
authors.initials: Mde M
authors.lastname: Rieder
authors.affiliation: Hospital Cristo Redentor, Porto Alegre, RS, BR.
authors.forename: Carla
authors.initials: C
authors.lastname: Meneguzzi
authors.affiliation: Instituto Porto Alegre, Centro Universitário Metodista, RS, BR.
authors.forename: Amanda Soares
authors.initials: AS
authors.lastname: Skueresky
authors.affiliation: Instituto Porto Alegre, Centro Universitário Metodista, RS, BR.
authors.forename: Luiz Alberto
authors.initials: LA
authors.lastname: Forgiarini Junior
authors.affiliation: Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR.
authors.forename: Marino Muxfeldt
authors.initials: MM
authors.lastname: Bianchin
mesh_terms: D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000379:methods*; D001930:Brain Injuries; D001938:Brazil; D003371:Cough / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007320:Inspiratory Capacity; D020300:Intracranial Hemorrhages; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000628:therapy; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D012372:ROC Curve; D012018:Reflex / Q000502:physiology*; D012121:Respiration, Artificial; D018709:Statistics, Nonparametric