Semi-quantitative Cough Strength Score as a Predictor for Extubation Outcome in Traumatic Brain Injury: A Prospective Observational Study

Ibrahim, Abdelrady S; Aly, Mahmoud; Abdel-Rahman, Khaled A; Mohamed, Mona A. A.; Mehany, Mogedda Mohamed; Aziz, Eman Mamdouh

doi:10.1007/s12028-018-0539-3

Cited by 12 publications

(12 citation statements)

References 24 publications

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“…S4 in the additional material). High risk of bias was related to the study participation in eight studies [ 47 , 57 , 78 – 82 , 85 ], to study attrition in one study [ 33 ], to prognostic factor measurement in one study [ 7 ], to the outcome measurement in two studies [ 29 , 77 ] and to study confounding in five studies [ 27 , 65 , 78 , 81 , 85 ]. The remaining studies had low or unclear risk of bias for each of the six domains.…”

Section: Resultsmentioning

confidence: 99%

Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis

et al. 2021

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Background Extubation failure is an important issue in ventilated patients and its risk factors remain a matter of research. We conducted a systematic review and meta-analysis to explore factors associated with extubation failure in ventilated patients who passed a spontaneous breathing trial and underwent planned extubation. This systematic review was registered in PROPERO with the Registration ID CRD42019137003. Methods We searched the PubMed, Web of Science and Cochrane Controlled Register of Trials for studies published from January 1998 to December 2018. We included observational studies involving risk factors associated with extubation failure in adult intensive care unit patients who underwent invasive mechanical ventilation. Two authors independently extracted data and assessed the validity of included studies. Results Sixty-seven studies (involving 26,847 participants) met the inclusion criteria and were included in our meta-analysis. We analyzed 49 variables and, among them, we identified 26 factors significantly associated with extubation failure. Risk factors were distributed into three domains (comorbidities, acute disease severity and characteristics at time of extubation) involving mainly three functions (circulatory, respiratory and neurological). Among these, the physiological respiratory characteristics at time of extubation were the most represented. The individual topic of secretion management was the one with the largest number of variables. By Bayesian multivariable meta-analysis, twelve factors were significantly associated with extubation failure: age, history of cardiac disease, history of respiratory disease, Simplified Acute Physiologic Score II score, pneumonia, duration of mechanical ventilation, heart rate, Rapid Shallow Breathing Index, negative inspiratory force, lower PaO2/FiO2 ratio, lower hemoglobin level and lower Glasgow Coma Scale before extubation, with the latest factor having the strongest association with extubation outcome. Conclusions Numerous factors are associated with extubation failure in critically ill patients who have passed a spontaneous breathing trial. Robust multiparametric clinical scores and/or artificial intelligence algorithms should be tested based on the selected independent variables in order to improve the prediction of extubation outcome in the clinical scenario.

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Section: Resultsmentioning

confidence: 99%

Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis

et al. 2021

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“…The predictive value of a successful SBT for ventilator liberation in patients with brain injury is largely unknown. Recent studies have demonstrated higher extubation failure rates after a successful SBT in patients with brain injury compared with general critically ill patients (19)(20)(21)(22)(23). After a successful SBT, extubation failure rates between 31% and 46% have been reported in patients with brain injury.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, 10-14% of general critically ill patients completing an SBT failed ventilator liberation (24)(25)(26)(27). Reasons for the high failure rates in patients with brain injury may be related to upper airway function or neurological status (19,21,23). Therefore, guidelines specifically recommend assessment for airway protective ability, including suctioning frequency, cough strength, and mental status (11,28).…”

Section: Introductionmentioning

confidence: 99%

Role of a successful spontaneous breathing trial in ventilator liberation in brain-injured patients

Shi¹,

Jonkman²,

Tuinman³

et al. 2021

Ann Transl Med

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Background: Spontaneous breathing trials (SBTs) have been shown to improve outcomes in critically ill patients. However, in patients with brain injury, indications for intubation and mechanical ventilation are different from those of non-neurological patients, and the role of an SBT in patients with brain injury is less established. The aim of the present study was to compare key respiratory variables acquired during a successful SBT between patients with successful ventilator liberation versus failed ventilator liberation.Methods: In this prospective study, patients with brain injury (≥18 years of age), who completed a 30-min SBT, were enrolled. Airway pressure, flow, esophageal pressure, and diaphragm electrical activity (ΔEAdi) were recorded before (baseline) and during the SBT. Respiratory rate (RR), tidal volume, inspiratory muscle pressure (ΔPmus), ΔEAdi, and neuromechanical efficiency (ΔPmus/ΔEAdi) of the diaphragm were calculated breath by breath and compared between the liberation success and failure groups. Failed liberation was defined as the need for invasive ventilator assistance within 48 h after the SBT.Results: In total, 46 patients (51.9±13.2 years, 67.4% male) completed the SBT. Seventeen (37%) patients failed ventilator liberation within 48 h. Another 11 patients required invasive ventilation within 7 days after completing the SBT. There were no differences in baseline characteristics between the success and failed groups. In-depth analysis showed similar changes in patterns and values of respiratory physiological parameters between the groups.Conclusions: In patients with brain injury, ventilator liberation failure was common after successful SBT.In-depth physiological analysis during the SBT did not provide data to predict successful liberation in these patients.Trial registration: The trial was registered at ClinicalTrials.gov (No. NCT02863237).

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“…This classi cation is divided into three grades: strong, medium, and weak. There have also been four [8,9,12,17] studies which looked for any correlation between a patient's cough ability and the effectiveness of noninvasive mechanical ventilation [10] . These studies demonstrated that the worse the cough ability, the higher their risk of failing noninvasive mechanical ventilation, and the higher their in-hospital mortality [15][16] .…”

Section: Introductionmentioning

confidence: 99%

“…However, these studies mainly focused on the cough ability of patients receiving mechanical ventilation, there is still a lack of data comparing patients' initial cough ability and outcomes. This will be a prospective, observational study using the Cough Re ex Intensity Score, which is based on a previously proposed cough strength classi cation [17,21,23] . This study will aim to determine whether the Cough Re ex Intensity Score is effective at assessing a patient's risk for airway sputum obstruction, respiratory infection, or mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

The Cough Reflex Intensity Score in Critically Ill Patients’ Airway Management: Study Protocol for a Multicenter, Prospective, Observational Trial

Jia

Wang

Walline

et al. 2021

Preprint

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Background A patient’s ability to cough is important for assessing a patient’s airway condition and likely mechanical ventilation outcome,there is still a lack of data comparing patients’ initial cough ability and outcomes. Methods The study is a prospective, observational trial which includes 144 patients from Xinjiang Medical University. After a patients is assigned a cough strength score, the cough intensity assessments will be implemented every other day for a week. The primary endpoint is whether the patient requires endotracheal intubation (including tracheostomy). Secondary endpoints include time spent under mechanical ventilation (excluding noninvasive ventilation), ICU and hospital lengths of stay, hospital expenses and in-hospital 30-day mortality. Discussion Anecdotally in our practice, we found that patients with a high Cough Reflex Intensity Score don't require endotracheal intubation, while patients with a low score always need to be intubated. This trial will test to what degree cough intensity is correlated to patient’s outcomes. Trial registration: Chinese Clinical Trial Registry,ChiCTR1900028265. Registered 16 December 2019

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Semi-quantitative Cough Strength Score as a Predictor for Extubation Outcome in Traumatic Brain Injury: A Prospective Observational Study

Abstract: SCSS has shown promise in predicting successful extubation in TBI.

Cited by 12 publications

References 24 publications

Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis

Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis

Role of a successful spontaneous breathing trial in ventilator liberation in brain-injured patients

The Cough Reflex Intensity Score in Critically Ill Patients’ Airway Management: Study Protocol for a Multicenter, Prospective, Observational Trial

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