Use of Cough Peak Flow Measured by a Ventilator to Predict Re-Intubation When a Spirometer Is Unavailable

Bai, Linfu; Duan, Jun

doi:10.4187/respcare.05260

Cited by 24 publications

(31 citation statements)

References 23 publications

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“…As a predictor of extubation failure, PCED appears to be as accurate as CPF after a successful SBT. These results are consistent with those of previous studies, which reported that low CPF was significantly associated with extubation failure and that PCED was significantly correlated with CPF in healthy adults [8,9,[17][18][19][20][21]. This is the first study to investigate associations of ultrasonographic indices of diaphragm movement during cough with simultaneously measured CPF and extubation outcome in mechanically ventilated patients.…”

Section: Discussionsupporting

confidence: 92%

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Ultrasonographic measurement of the diaphragm movement during cough and extubation outcomes

Norisue¹,

Santanda²,

Nabeshima³

et al. 2020

Preprint

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Background: A cough peak flow (CPF) of <60 L/min was significantly associated with increased risk of extubation failure after a successful spontaneous breathing trial (SBT). Passive cephalic excursion of the diaphragm (PCED), measured by ultrasonography during cough expiration, was reported to predict CPF in healthy adults. We hypothesized that PCED, diaphragm peak velocity, or both, during cough, as measured by ultrasonography, might predict CPF and extubation outcome in mechanically ventilated patients. This study attempted to identify associations of ultrasonographic indices of the diaphragm with simultaneously measured CPF and to investigate the predictive values of ultrasonographic indices for extubation outcomes after a successful SBT.Methods: Two hundred fifty-two (252) mechanically ventilated patients with a successful SBT were enrolled in the prospective cohort study. Right hemidiaphragm passive cephalic excursion and peak velocity were measured by ultrasonography during voluntary cough expiration with maximum effort. CPF was measured simultaneously with ultrasonographic measurements.Results: A multiple regression model adjusted for age and sex showed a significant association between PCED and CPF (P < 0.001, adjusted beta coefficient 11.4, 95% CI 8.88–14.0, adjusted R2 = 0.287) and between diaphragm peak velocity and CPF (P < 0.001, adjusted beta coefficient 1.71, 95% CI 1.91–2.24, adjusted R2 = 0.235). The areas under the curves of PCED, diaphragm peak velocity, and CPF for extubation failure were 0.791 (95% Cl 0.668–0.914), 0.587 (95% Cl 0.426–0.748), and 0.765 (95% Cl 0.609–0.922), respectively.Conclusions: PCED measured by ultrasonography significantly predicted CPF and extubation failure after a successful SBT.

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Section: Discussionsupporting

confidence: 92%

“…Peak velocity of the diaphragm was measured by placing the tissue Doppler imaging cursor at the posterior one-third of the right hemidiaphragm ( Figure 2) [15]. Simultaneous measurement of CPF was performed for both coughs by using the internal flow meter of the ventilator (PB840, Covidien, Mansfield, MA, USA) [17].…”

Section: Observations and Measurementsmentioning

confidence: 99%

Ultrasonographic measurement of the diaphragm movement during cough and extubation outcomes

Norisue¹,

Santanda²,

Nabeshima³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In the previous studies, CPF was measured with various devices, such as flow meters, spirometers and pneumotachographs. However, not all medical facilities provide these devices [14]. Moreover, the complex device setup, including firmly attaching the facemasks and infection control filters on the patient [1], imposes burdens on both patients and their caregivers.…”

Section: Introductionmentioning

confidence: 99%

Estimation of Cough Peak Flow Using Cough Sounds

Umayahara

Soh

Sekikawa

et al. 2018

Sensors

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Cough peak flow (CPF) is a measurement for evaluating the risk of cough dysfunction and can be measured using various devices, such as spirometers. However, complex device setup and the face mask required to be firmly attached to the mouth impose burdens on both patients and their caregivers. Therefore, this study develops a novel cough strength evaluation method using cough sounds. This paper presents an exponential model to estimate CPF from the cough peak sound pressure level (CPSL). We investigated the relationship between cough sounds and cough flows and the effects of a measurement condition of cough sound, microphone type and participant’s height and gender on CPF estimation accuracy. The results confirmed that the proposed model estimated CPF with a high accuracy. The absolute error between CPFs and estimated CPFs were significantly lower when the microphone distance from the participant’s mouth was within 30 cm than when the distance exceeded 30 cm. Analysis of the model parameters showed that the estimation accuracy was not affected by participant’s height or gender. These results indicate that the proposed model has the potential to improve the feasibility of measuring and assessing CPF.

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“…Various spirometers [3,[23][24][25][26] and peak flow meters [24,[26][27][28][29][30] are used for CPF measurement. Moreover, various flow sensors, such as a pneumotachograph [21,[23][24][25]31] that measures respiratory flow using differential pressure sensors, a constant temperature hot-wire flow sensor ( Figure 2a) [26,32] and an ultrasonic sensor [33], are used in spirometers. In particular, the peak flow meter that can measure the flow rate using a spring-loaded piston is most commonly used because of its small size and ease of use, enabling patients to measure CPF by themselves ( Figure 2b).…”

Section: Cough Mechanism and Related Factors Influencing Cpfmentioning

confidence: 99%

“…CPF was measured using various devices (Figure 2). However, some medical facilities do not provide these devices [25], and some studies have used a semiquantitative cough strength assessment method [47,48]. Moreover, the complex setup of the device, including firm attachment of the facemask and infection control filter to the patient, imposes a burden on both patients and caregivers.…”

Section: Cpf Estimation Model Using Cough Soundsmentioning

confidence: 99%

Clinical Significance of Cough Peak Flow and Its Non-Contact Measurement via Cough Sounds: A Narrative Review

et al. 2020

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Coughing is the primary defence mechanism against foreign bodies in the central airways and can quantitatively be assessed by cough peak flow (CPF). We conducted a narrative review of the literature on CPF, which is most commonly used for evaluating cough strength. This review regards the method for measurement of CPF, the cough-related factors influencing CPF, the clinical significance of CPF evaluation, and a novel cough strength prediction method using cough sounds. Furthermore, this review presents various cutoff thresholds that predict extubation failure in patients on mechanical ventilation, acute respiratory failure, and aspiration risk. The published clinical evidence of CPF demonstrates reasonable diagnostic accuracy, predictive power, and validity, although additional studies on the non-contact measurement of CPF via cough sounds with better-quality methodologies are required.

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Use of Cough Peak Flow Measured by a Ventilator to Predict Re-Intubation When a Spirometer Is Unavailable

Abstract: CPF measurement by a ventilator was convenient, affordable, and safe. It had a predictive accuracy for re-intubation similar to that of a spirometer.

Cited by 24 publications

References 23 publications

Ultrasonographic measurement of the diaphragm movement during cough and extubation outcomes

Ultrasonographic measurement of the diaphragm movement during cough and extubation outcomes

Estimation of Cough Peak Flow Using Cough Sounds

Clinical Significance of Cough Peak Flow and Its Non-Contact Measurement via Cough Sounds: A Narrative Review

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