Document Detail


Interest of an objective evaluation of cough during weaning from mechanical ventilation.
MedLine Citation:
PMID:  19169666     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: This study aimed to evaluate an objective measure of cough strength, the peak cough expiratory flow (PCEF), as a predictive criterion of success or failure of extubation. METHODS: Patients under mechanical ventilation for more than 24 h who successfully passed the spontaneous breathing trial were included in the study. Just before extubation, PCEF was measured with an electronic flowmeter. RESULTS: A total of 130 patients were included. The median duration of mechanical ventilation before extubation was 8 days (4-17). Fourteen patients (10.8%) failed extubation. The sole factor significantly associated with extubation failure was the measure of PCEF. The patients who did not cough at order had a higher rate of extubation failure than those who did (P = 0.03). The mean PCEF of patients who failed extubation (36.3 +/- 15 l/min) was significantly lower than the one of patients who succeeded (63.6 +/- 32 l/min) (P < 0.001). The optimal cut-off value of PCEF was 35 l/min. Overall, an inability to cough at order or a PCEF < or =35 l/min predicted extubation failure with a sensitivity of 79% and a specificity of 71%. The risk of extubation failure was 24% for the patients who did not cough at order or with a PCEF < or =35 l/min and 3.5% for those with a PCEF >35 l/min [RR = 6.9 (95% CI, 2-24); P = 0.002]. CONCLUSIONS: This study confirmed the interest of measuring the PCEF to predict extubation outcome in patients having successfully passed the spontaneous breathing trial.
Authors:
Pascal Beuret; Christophe Roux; Annie Auclair; Karim Nourdine; Mahmoud Kaaki; Marie-Jose Carton
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Publication Detail:
Type:  Journal Article     Date:  2009-01-24
Journal Detail:
Title:  Intensive care medicine     Volume:  35     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-26     Completed Date:  2009-09-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1090-3     Citation Subset:  IM    
Affiliation:
Intensive Care Unit, Centre Hospitalier Roanne, 28 rue de Charlieu, 42328 Roanne, France. pascal.beuret@ch-roanne.fr
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MeSH Terms
Descriptor/Qualifier:
Aged
Cough*
Female
Forced Expiratory Flow Rates / physiology
France
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Predictive Value of Tests
Ventilator Weaning / standards*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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