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Respiratory Care |

Cough Strength as Predictor of Extubation Outcome for Patients Weaned From Mechanical Ventilation

Roland Panaligan*, MD; Ma. Katrina Simon, MD; Patrick Gerard Moral, MD
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UST Hospital, Manila, Philippines


Chest. 2012;142(4_MeetingAbstracts):938A. doi:10.1378/chest.1388933
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Abstract

SESSION TYPE: Respiratory Support Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To maximize the likelihood for successful extubation, the patient should be capable of maintaining a patent airway and generating adequate spontaneous ventilation. Tests for airway protection such as coughing and airway patency assess the appropriate timing of extubation.

METHODS: Twenty six patients weaned from ventilators, and passed any of the following: a 2-hour spontaneous breathing trial (SBT) via T-piece, or continuous positive airway pressure with pressure support < 7 cm H2O, and were assessed by their physician to be ready for extubation in the critical units and general wards of a tertiary teaching hospital were included from August to October 2011. Involuntary cough was induced by 2 mL of normal saline solution instillation through the endotracheal tube at the end of inspiration and graded using a semi-objective scale (0 - no cough response, 1 - audible movement of air through the endotracheal tube but no audible cough, 2 - strong cough with phlegm under the end of endotracheal tube, 3 - strong cough with phlegm coming out of the end of endotracheal tube). All patients were then extubated.

RESULTS: 26 patients were included in this study, 19 (73.1%) were successfully extubated, and 7 (26.9%) patients failed extubation. Patients who failed extubation were older (>65 years), had lower cough strength scores (score of 1), had longer duration of intubation (median 8.5 days), and lower P/F values (<200).

CONCLUSIONS: Involuntary cough strength has the potential to predict successful extubation among patients who pass spontaneous breathing trial and assessed accordingly to be ready for extubation.

CLINICAL IMPLICATIONS: Determination of involuntary cough strength as a predictor of extubation outcome is a non-expensive parameter that may be used in centers where a cough peak flow meter for quantitative cough assessment is not available.

DISCLOSURE: The following authors have nothing to disclose: Roland Panaligan, Ma. Katrina Simon, Patrick Gerard Moral

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UST Hospital, Manila, Philippines

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