title: Noninvasive ventilation for avoidance of reintubation in patients with various cough strength.
abstract: BACKGROUND
  Reintubation is associated with high mortality. Identification of methods to avoid reintubation is needed. The aim of this study was to assess whether prophylactic noninvasive ventilation (NIV) would benefit patients with various cough strengths.
  
  
  METHODS
  We prospectively enrolled 356 patients who successfully passed a spontaneous breathing trial in a respiratory intensive care unit. Before extubation, cough peak flow was measured. After extubation, attending physicians determined whether the patients would receive prophylactic NIV or conventional oxygen treatment (control group). Patients were followed up to 90 days postextubation or death, whichever came first.
  
  
  RESULTS
  The median value of cough peak flow was 70 L/minute. Among the patients with cough peak flow ≤70 L/minute, 108 received NIV and 72 received conventional oxygen treatment. In this cohort, NIV reduced reintubation (9 % vs. 35 % at postextubation 72 h, p < 0.01; and 24 % vs. 49 % at postextubation 7 days, p < 0.01) and postextubation 90-day mortality (43 % vs. 61 %, p = 0.02) compared with the control group. Further, use of NIV was an independent protective factor for reintubation (OR = 0.19, p < 0.01 at 72 h postextubation; and OR = 0.33, p < 0.01 at 7 days postextubation) and for death at 90 days postextubation (OR = 0.40, p = 0.02). Among patients with cough peak flow >70 L/minute, 71 received NIV and 105 received conventional oxygen treatment. In this cohort, NIV did not reduce reintubation (6 % vs. 6 % at 72 h postextubation, p > 0.99; and 9 % vs. 9 % at 7 days postextubation, p > 0.99) or postextubation 90-day mortality (21 % vs. 15 %, p = 0.32) compared with the control group. Further, use of NIV was not associated with reintubation or postextubation 90-day mortality.
  
  
  CONCLUSIONS
  In a planned extubated population, prophylactic NIV benefited patients with weak cough but possibly not in patients with strong cough.
authors.affiliation: Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, People's Republic of China. duanjun412589@163.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Duan
authors.affiliation: Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, People's Republic of China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Han
authors.affiliation: Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, People's Republic of China.
authors.forename: Shicong
authors.initials: S
authors.lastname: Huang
authors.affiliation: Department of Respiratory Medicine, First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, People's Republic of China.
authors.forename: Linfu
authors.initials: L
authors.lastname: Bai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003371:Cough / Q000145:classification / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000379:methods* / Q000592:standards; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D011014:Pneumonia / Q000150:complications; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012121:Respiration, Artificial / Q000009:adverse effects / Q000592:standards*; D018709:Statistics, Nonparametric; D015300:Ventilator Weaning / Q000379:methods*
keywords: Cough strength; Noninvasive ventilation; Reintubation; Ventilator weaning