Abstract
BackgroundA patient’s ability to clear secretions and protect the airway with an effective cough is an important part of the pre-extubation evaluation. An increase in intra-abdominal pressure (IAP) is important in generating the flow rate necessary for a cough. This study investigated whether an increase from baseline in IAP during a coughing episode induced by routine pre-extubation airway suctioning is associated with extubation outcome after a successful spontaneous breathing trial (SBT).MethodsThree hundred thirty-five (335) mechanically ventilated patients who passed an SBT were enrolled. Baseline IAP and peak IAP during successive suctioning-induced coughs were measured with a fluid column connected to a Foley catheter.ResultsExtubation was unsuccessful in 24 patients (7.2%). Unsuccessful extubation was 3.40 times as likely for patients with a delta IAP (ΔIAP) of ≤ 30 cm H2O than for those with a ΔIAP > 30 cm H2O, after adjusting for APACHE II score (95% CI, 1.39–8.26; p = .007).ConclusionΔIAP during a coughing episode induced by routine pre-extubation airway suctioning is significantly associated with extubation outcome in patients with a successful SBT.Trial registration UMIN-CTR Clinical Trial, UMIN000017762. Registered 1 June 2015.
Highlights
A patient’s ability to clear secretions and protect the airway with an effective cough is an important part of the pre-extubation evaluation
Previous studies reported that an involuntary cough peak expiratory flow (CPEF) of < 60 L/min was significantly associated with increased risk of extubation failure [5, 9, 10]
Univariate analysis showed that CAMICU, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score II score, intubation days, length of intensive care unit (ICU) stay, length of hospital stay, 28-day mortality, and in-hospital mortality were significantly higher, and P/F ratio was significantly lower, in the extubation failure group than in the extubation success group
Summary
A patient’s ability to clear secretions and protect the airway with an effective cough is an important part of the pre-extubation evaluation. This study investigated whether an increase from baseline in IAP during a coughing episode induced by routine pre-extubation airway suctioning is associated with extubation outcome after a successful spontaneous breathing trial (SBT). In addition to methods that focus on CPEF, clinicians desire a procedure that would allow evaluation of involuntary cough strength among patients who are unable or unwilling to produce maximal cough effort without special devices. This procedure would not require disconnecting the patient from the ventilator circuit during routine pre-extubation airway suctioning, as this almost always induces cough
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