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Original Research: CRITICAL CARE MEDICINE |

Involuntary Cough Strength and Extubation Outcomes for Patients in an ICU

Wen-Lin Su, MD, MPH; Yeong-Hwang Chen, MD, MPH; Chien-Wen Chen, MD; Shih-Hsing Yang, MS; Chien-Ling Su, MS; Wann-Cherng Perng, MD; Chin-Pyng Wu, MD, PhD; Jenn-Han Chen, PhD
Author and Funding Information

From the Graduate Institute of Medical Sciences (Drs W.-L. Su, Y.-H. Chen, Perng, Wu, and J.-H. Chen), National Defense Medical Center, Taipei; Division of Pulmonary and Critical Care Medicine (Drs W.-L. Su, C.-W. Chen, and Perng), Department of Medicine, Tri-Service General Hospital, Nei-Hu, Taipei; Department of Respiratory Therapy (Mr Yang), Fu-Jen Catholic University, Taipei; the School of Respiratory Therapy (Ms C.-L. Su), and Graduate Institute of Clinical Medicine (Dr J.-H. Chen), Taipei Medical University, Taipei; Landseed Hospital (Dr Wu), Tao-Yuan County; and Wan Fang Hospital (Dr J.-H. Chen), Taipei, Taiwan, Republic of China.

Correspondence to: Chin-Pyng Wu, MD, PhD, Graduate Institute of Medical Sciences, National Defense Medical Center, No 161, Sec. 6, Mincyuan E Rd, Neihu District, Taipei City 114, Taiwan, ROC; e-mail: chinpyng@ndmctsgh.edu.tw


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(4):777-782. doi:10.1378/chest.07-2808
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Background:  Removing the artificial airway is the last step in the mechanical ventilation withdrawal process. In order to assess cough effectiveness, a critical component of this process, we evaluated the involuntary cough peak flow (CPFi) to predict the extubation outcome for patients weaned from mechanical ventilation in ICUs.

Methods:  One hundred fifty patients were weaned from ventilators, passed a spontaneous breathing trial (SBT), and were judged by their physician to be ready for extubation in the Tri-Service General Hospital ICUs from February 2003 to July 2003. CPFi was induced by 2 mL of normal saline solution at the end of inspiration and measured using a hand-held respiratory mechanics monitor. All patients were then extubated.

Results:  Of 150 enrolled patients for this study, 118 (78.7%) had successful extubation and 32 (21.3%) failed. In the univariate analysis, there were higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (16.0 vs 18.5, P = .018), less negative maximum inspiratory pressure (−45.0 vs −39.0, P = .010), lower cough peak flows (CPFs) (74.0 vs 42.0 L/min, P < .001), longer postextubation hospital stays (15.0 vs 31.5 days, P < .001), and longer postextubation ICU stays (1.0 vs 9.5 days, P < .001) in the extubation failures compared with the extubation successes. In the multivariate analysis, we found that a higher APACHE II score and a lower CPF were related to increasing risk of extubation failure (odds ratio [OR] = 1.13; 95% CI, 1.03-1.25; and OR = 0.95; 95% CI, 0.93-0.98, respectively). The receiver operator characteristic curve cutoff point for CPF was 58.5 L/min, with a sensitivity of 78.8% and specificity of 78.1%.

Conclusions:  CPFi as an indication of cough reflex has the potential to predict successful extubation in patients who pass an SBT.

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