Involuntary Cough Strength and Extubation Outcomes for Patients in an ICU

Su, Wan‐Fu; Chen, Yeong Hwang; Chen, Chien-Wen; Yang, Shih Hsing; Su, Chien Ling; Perng, Wann Cherng; Wu, Chin Pyng; Chen, Jenn Han

doi:10.1378/chest.07-2808

Cited by 96 publications

(112 citation statements)

References 17 publications

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“…1). 16 As with V-CPF measurements, the best of three measurements was used as the recorded value for IV-CPF.…”

Section: Methodsmentioning

confidence: 99%

“…[12][13][14][15] Patients with low V-CPF had a high risk of re-intubation after scheduled extubation. Su et al 16 reported that involuntary cough peak flow (IV-CPF), also measured before extubation, showed similar accuracy in predicting re-intubation. However, which of the two methods is more accurate in predicting re-intubation is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects

et al. 2014

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BACKGROUND:In this study, we compared the predictive accuracy of voluntary cough peak flow (V-CPF) and involuntary cough peak flow (IV-CPF) for re-intubation in mechanically ventilated subjects. METHODS: Endotracheally intubated patients who passed a spontaneous breathing trial and assessment of readiness for extubation were enrolled. Before extubation, V-CPF and IV-CPF were measured. Re-intubation was recorded at 72 h after extubation. RESULTS: A total of 115 extubations in 106 cooperative subjects (including 9 subjects with second extubation) and 5 extubations in 5 uncooperative subjects were recorded. At 72 h, 20 (17.4%) and 1 (25%) instances of re-intubation occurred in cooperative and uncooperative subjects, respectively. In cooperative subjects, those who had been successfully extubated had higher V-CPF than re-intubated subjects

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“…1). 16 As with V-CPF measurements, the best of three measurements was used as the recorded value for IV-CPF.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects

et al. 2014

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“…62 Cough velocities of 0.5-1.0 L/s have also been shown in other studies to be compatible with successful extubation. 63 The importance of intact cognitive function on extubation success is controversial. Successful extubations have been reported in a select group of brain-injured, comatose patients who were judged to be capable of protecting their airways.…”

Section: Assessing the Need For An Artificial Airwaymentioning

confidence: 99%

The Ventilator Discontinuation Process: An Expanding Evidence BaseDiscussion

MacIntyre

2013

Respir Care

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The ventilator discontinuation process is an essential component of overall ventilator management. Undue delay leads to excess stay, iatrogenic lung injury, unnecessary sedation, and even higher mortality. On the other hand, premature withdrawal can lead to muscle fatigue, dangerous gas exchange impairment, loss of airway protection, and also a higher mortality. Continued ventilator dependence can be a result of persistent illness or can be a result of poor management. It is obviously important for the clinician to be able to assess both of these issues. An evidence-based task force has recommended regular assessments focusing on the causes of ventilator dependence, regular assessments for evidence of disease stability/reversal, use of regular spontaneous breathing trials (SBTs) as the primary assessment tool for ventilator discontinuation potential, use of separate assessments to evaluate the need for an artificial airway in patients tolerating the SBT, and the use of comfortable, interactive ventilator modes (that do not need to be "weaned") in between regular SBTs. More recent developments have focused on the importance of linking sedation reduction protocols to ventilator discontinuation protocols. Patients with repeated SBT failures are often considered to require prolonged mechanical ventilation (PMV). These patients often receive tracheostomies and are probably better managed with more gradual reductions in support and gradually lengthened spontaneous breathing periods. PMV patients have a high 1-year mortality, and many may ultimately require lifelong support. This evidence base is growing, but the earlier guidelines are standing the test of time. Indeed, practice patterns are evolving in accordance with them. Nevertheless, there is still room for improvement, and further clinical studies, especially in the patient requiring PMV, are needed.

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“…In intubated patients a spontaneous cough PEF threshold value of 1 L/s was consistently found to predict extubation failure. 1,12 Again, the effect of CoughAssist was not assessed in those patients. In tracheally intubated and mechanically ventilated patients with neuromuscular diseases, much higher assisted PEF threshold values predicted extubation failure, 13 as discussed below.…”

Section: Effects Of Artificial Airways On Peak Flow During Exsufflationmentioning

confidence: 99%

Performance of the CoughAssist Insufflation-Exsufflation Device in the Presence of an Endotracheal Tube or Tracheostomy Tube: A Bench Study

et al. 2011

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Involuntary Cough Strength and Extubation Outcomes for Patients in an ICU

Cited by 96 publications

References 17 publications

Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects

Voluntary Is Better Than Involuntary Cough Peak Flow for Predicting Re-Intubation After Scheduled Extubation in Cooperative Subjects

The Ventilator Discontinuation Process: An Expanding Evidence BaseDiscussion

Performance of the CoughAssist Insufflation-Exsufflation Device in the Presence of an Endotracheal Tube or Tracheostomy Tube: A Bench Study

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