The application of fibrobronchoscopy in extubation for patients suffering from acute exacerbation of chronic obstructive pulmonary disease with low cough peak expiratory flow

Abstract

To investigate the value of the application of fibrobronchoscopy in extubation for patients suffering from acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with low cough peak expiratory flow (CPEF). A single-center prospective controlled study was conducted. The ventilated AECOPD patients who were cooperative at the time of extubation in Department of Critical Care Medicine of Guangzhou Institute of Respiratory Disease of Guangzhou Medical University from June 2009 to May 2014 were enrolled. All patients successfully passed the spontaneous breathing trial (SBT). Extubation was performed after determination of CPEF following energetic coughing. According to the CPEF, the patients were divided into CPEF ≥ 60 L/min group (high CPEF group) and CPEF<60 L/min group (low CPEF group). After extubation, fibrobronchoscopic drainage was given to the patients in high CPEF group when necessary. Fibrobronchoscopic drainage was given to the patients in low CPEF group at least once a day, and the frequency of such treatment could be increased according to the patient's condition. If the patients did not require re-intubation within 48 hours,extubation was recorded as successful. The gender, age, acute physiology and chronic health evaluationII (APACHEII) score before extubation, ventilation time, the time of intensive care unit (ICU) stay, the mortality in ICU, the rate of re-intubation, the ability to cough and the frequency of application of fibrobronchoscopy after extubation were recorded. A total of 102 patients with AECOPD were enrolled, 58 patients in high CPEF group and 44 in low CPEF group. Compared with high CPEF group, the mean age in low CPEF group was older (years: 74.3 ± 15.2 vs. 69.5 ± 11.4, t=2.164, P=0.041), the time of ICU stay was significantly longer (days: 20.1 ± 11.2 vs. 17.4±7.3, t=2.274, P=0.030), but there was no significant difference in gender [male/female (cases):35/9 vs. 45/13, χ² = 0.057, P=0.812], APACHEII score (11.9 ± 1.9 vs. 10.3 ± 4.2, t=1.290, P=0.200), mechanical ventilation time (days: 14.8 ± 10.8 vs. 13.3 ± 9.6, t=0.677, P=0.501) and the rate of re-intubation [18.18% (8/44) vs. 12.07% (7/58), χ² = 1.412, P=0.235] between low CPEF group and high CPEF group. The cough strength of patients in high CPEF group was almost always "strong" (52 cases), and in the low CPEF group, most of them was "moderate" (14 cases) or "weak" (26 cases). The frequency of application of fibrobronchoscopy in low CPEF group was higher than that in high CPEF group (times: 4.1 ± 1.8 vs. 1.3 ± 0.9, t=2.626, P=0.011). All patients underwent weaning successfully, and no death occurred. The application of fibrobronchoscopy in the extubated AECOPD patients with low CPEF can reduce the rate of re-intubation, avoid the prolonged ventilation, but cannot reduce the time of ICU stay.