Coughing correlates: insights into an innovative study using cough peak expiratory flow to predict extubation failure

Jiang, Chuan; Esquinas, António M.; Mina, Bushra

doi:10.1186/s13054-016-1574-0

Cited by 3 publications

(2 citation statements)

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“…The pathogenesis of POR in COPD patients may be attributed to the abnormal function of the small airways, which leads to increased airway resistance and aggravates respiratory muscle weakness during anesthesia recovery ( 16 ). Most preoperative COPD patients had difficulties in postoperative extubation; therefore, clinicians should strictly grasp the indications of tracheal extubation in elderly COPD patients, and ventilator-assisted ventilation should be used when necessary ( 22 ). Hence, greater consideration should be given to COPD patients during preoperative evaluation, and more caution is warranted during perioperative management.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Post-operative Planned Reintubation in Patients After General Anesthesia: A Systematic Review and Meta-Analysis

et al. 2022

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BackgroundThe occurrence of postoperative reintubation (POR) in patients after general anesthesia (GA) is often synonymous with a poor prognosis in patients. This is the first review analyzing scientific literature to identify risk factors of POR after general anesthesia. The purpose of this study was to collect currently published studies to determine the most common and consistent risk factors associated with POR after GA.MethodsWe have retrieved all relevant research published before April 2021 from PubMed, Embase, Web of Science, and the Cochrane Library electronic databases. These studies were selected according to the inclusion and exclusion criteria. The Z test determined the combined odds ratio (OR) of risk factors. We used OR and its corresponding 95% confidence interval (CI) to identify significant differences in risk factors. The quality of the study was evaluated with the NOS scale, and meta-analysis was carried out with Cochrane Collaboration's Revman 5.0 software.ResultsA total of 10 studies were included, with a total of 7,789 recipients of POR. We identified 7 risk factors related to POR after GA: ASA ≥ 3 (OR = 3.58), COPD (OR = 2.09), thoracic surgery (OR = 17.09), airway surgery (OR = 9.93), head-and-neck surgery (OR = 3.49), sepsis (OR = 3.50), DVT (OR = 4.94).ConclusionOur meta-analysis showed that ASA ≥ 3, COPD, thoracic surgery, airway surgery, head-and-neck surgery, sepsis and DVT were associated with POR after GA.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?, Identifier: CRD42021252466.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Post-operative Planned Reintubation in Patients After General Anesthesia: A Systematic Review and Meta-Analysis

et al. 2022

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“…In a study of 356 patients in a respiratory ICU, consisting largely of patients with COPD exacerbation, they demonstrated that prophylactic use of non-invasive ventilation (NIV) in patients with a CPEF < 70 L/min led to reduced extubation failures compared to non-use of NIV [ 24 ]. We had previously praised this elegant study [ 25 ] for advancing the literature of the selection of patients with COPD exacerbation for use of NIV in the postextubation period [ 26 , 27 ].…”

Section: Main Textmentioning

confidence: 99%

Evaluation of cough peak expiratory flow as a predictor of successful mechanical ventilation discontinuation: a narrative review of the literature

2017

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A crucial step in the transition from mechanical ventilation to extubation is the successful performance of a spontaneous breathing trial (SBT). The American College of Chest Physicians (ACCP) Guidelines recommend removal of the endotracheal tube upon successful completion of a SBT. However, this does not guarantee successful extubation as there remains a risk of re-intubation. Guidelines have outlined ventilator liberation protocols, selected use of non-invasive ventilation on extubation, early mobilization, and dynamic ventilator metrics to prevent and better predict extubation failure. However, a significant percentage of patients still fail mechanical ventilation discontinuation. A common reason for re-intubation is having a weak cough strength, which reflects the inability to protect the airway.Evaluation of cough strength via objective measures using peak expiratory flow rate is a non-invasive and easily reproducible assessment which can predict extubation failure. We conducted a narrative review of the literature regarding use of cough strength as a predictive index for extubation failure risk. Results of our review show that cough strength, quantified objectively with a cough peak expiratory flow measurement (CPEF), is strongly associated with extubation success. Furthermore, various cutoff thresholds have been identified and can provide reasonable diagnostic accuracy and predictive power for extubation failure.These results demonstrate that measurement of the CPEF can be a useful tool to predict extubation failure in patients on MV who have passed a SBT. In addition, the data suggest that this diagnostic modality may reduce ICU length of stay, ICU expenditures, and morbidity and mortality.

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Cough Peak Flow Assessment Without Disconnection From the ICU Ventilator in Mechanically Ventilated Patients

et al. 2023

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Coughing correlates: insights into an innovative study using cough peak expiratory flow to predict extubation failure

Cited by 3 publications

References 5 publications

Risk Factors for Post-operative Planned Reintubation in Patients After General Anesthesia: A Systematic Review and Meta-Analysis

Risk Factors for Post-operative Planned Reintubation in Patients After General Anesthesia: A Systematic Review and Meta-Analysis

Evaluation of cough peak expiratory flow as a predictor of successful mechanical ventilation discontinuation: a narrative review of the literature

Cough Peak Flow Assessment Without Disconnection From the ICU Ventilator in Mechanically Ventilated Patients

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