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Ge J, Niu G, Li Q, Li Y, Yang B, Guo H, Wang J, Zhang B, Zhang C, Zhou T, Zhao Z, Jiang H. Cough flows as a criterion for decannulation of autonomously breathing patients with tracheostomy tubes. Respir Res 2024; 25:128. [PMID: 38500141 PMCID: PMC10949589 DOI: 10.1186/s12931-024-02762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/08/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Adequate cough or exsufflation flow can indicate an option for safe tracheostomy decannulation to noninvasive management. Cough peak flow via the upper airways with the tube capped is an outcome predictor for decannulation readiness in patients with neuromuscular impairment. However, this threshold value is typically measured with tracheotomy tube removed, which is not acceptable culturally in China. The aim of this study was to assess the feasibility and safety of using cough flow measured with tracheostomy tube and speaking valve (CFSV) > 100 L/min as a cutoff value for decannulation. STUDY DESIGN Prospective observational study conducted between January 2019 and September 2022 in a tertiary rehabilitation hospital. METHODS Patients with prolonged tracheostomy tube placement were referred for screening. Each patient was assessed using a standardized tracheostomy decannulation protocol, in which CFSV greater than 100 L/min indicated that the patients' cough ability was sufficient for decannulation. Patients whose CFSV matched the threshold value and other protocol criteria were decannulated, and the reintubation and mortality rates were followed-up for 6 months. RESULTS A total of 218 patients were screened and 193 patients were included. A total of 105 patients underwent decannulation, 103 patients were decannulated successfully, and 2 patients decannulated failure, required reinsertion of the tracheostomy tube within 48 h (failure rate 1.9%). Three patients required reinsertion or translaryngeal intubation within 6 months. CONCLUSIONS CFSV greater than 100 L/min could be a reliable threshold value for successful decannulation in patients with various primary diseases with a tracheostomy tube. TRIAL REGISTRATION This observational study was not registered online.
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Affiliation(s)
- Jingyi Ge
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Guangyu Niu
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Qing Li
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Yi Li
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Bo Yang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Haiming Guo
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Jianjun Wang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Bin Zhang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Chenxi Zhang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Ting Zhou
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China
| | - Zhanqi Zhao
- School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China
- Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Hongying Jiang
- Department of Respiratory Rehabilitation Center, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China.
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Exploring the Influence of Dysphagia and Tracheostomy on Pneumonia in Patients with Stroke: A Retrospective Cohort Study. Brain Sci 2022; 12:brainsci12121664. [PMID: 36552123 PMCID: PMC9775301 DOI: 10.3390/brainsci12121664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Pneumonia is common in patients with tracheostomy and dysphagia. However, the influence of dysphagia and tracheostomy on pneumonia in patients with stroke remains unclear. The aim of this study was to explore the risk factors related to pneumonia, and the association between dysphagia, tracheostomy and pneumonia in patients with stroke was investigated. Methods: Patients with stroke who experienced tracheostomy and dysphagia were included and divided into two groups based on record of pneumonia at discharge. Clinical manifestations and physical examination were used to diagnose pneumonia, whereas clinical swallowing examination, and videofluoroscopy swallowing studies (VFSS) were used to evaluate swallowing function. Results: There were significant differences between the pneumonia group and the no pneumonia group in total tracheostomy time (6.3 ± 5.9 vs. 4.3 ± 1.7 months, p = 0.003), number of instances of ventilator support (0.41 ± 0.49 vs. 0.18 ± 0.38, p = 0.007), PAS score (5.2 ± 1.92 vs. 4.3 ± 1.79, p = 0.039), impaired or absent cough reflex (76.4 vs. 55.6%, p = 0.035), oropharyngeal phase dysfunction (60.6 vs. 40.8%, p = 0.047), length of hospital stay (36.0 ± 7.2 vs. 30.5 ± 11.7 days, p = 0.025) and direct medical costs (15,702.21 ± 14,244.61 vs. 10,923.99 ± 7250.14 United States dollar [USD], p = 0.042). Multivariate logistic regression showed that the total tracheostomy time (95% confidence interval [CI], 1.966−12.922, p = 0.001), impaired or absent cough reflex (95% CI, 0.084−0.695, p = 0.008), and oropharyngeal phase dysfunction (95% CI, 1.087−8.148, p = 0.034) were risk factors for pneumonia. Spearman’s correlation analysis demonstrated that PAS scores were significantly correlated with cough reflex dysfunction (r = 0.277, p = 0.03), oropharyngeal phase dysfunction (r = 0.318, p < 0.01) and total tracheostomy time (r = 0.178, p = 0.045). The oropharyngeal phase dysfunction was significantly correlated with cough reflex (r = 0.549, p < 0.001) and UES opening (r = 0.643, p < 0.01). Conclusions: Tracheostomy and dysphagia increased the risk of pneumonia in patients with stroke. Total tracheostomy time, duration of ventilator support, degree of penetration and aspiration, and oropharyngeal phase dysfunction are risk factors. Given this, we also found that there may be a correlation between tracheostomy and dysphagia.
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Sanchez-Guerrero JA, Guerlain J, Cebrià I Iranzo MÀ, Baujat B, Lacau St Guily J, Périé S. Expiratory airflow obstruction due to tracheostomy tube: A spirometric study in 50 patients. Clin Otolaryngol 2020; 45:703-709. [PMID: 32351009 DOI: 10.1111/coa.13561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 04/02/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Tracheostomy is commonly used in intensive care units and in head and neck departments. Airway obstruction due to occluded cuffless tracheostomy tubes themselves remains unknown, although capping trials are commonly used before decannulation. The aim of this study was to evaluate the extent to which airway obstruction can be caused by occluded cuffless tubes in patients who underwent head and neck surgery. DESIGN Prospective Research Outcome. SETTINGS University teaching hospital. PARTICIPANTS Fifty patients requiring transient tracheostomy after head and neck surgery. MAIN OUTCOME MEASURES A flow-volume loop (FVL) through the mouth using a portable spirometer, with the occluded fenestrated cuffless tube, was measured before and immediately after decannulation, by obstructing the orifice of tracheostomy tube. The measurement of FVL recorded the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1 ), peak expiratory flow (PEF), forced expiratory flow at 50% of FVC, peak inspiratory flow (PIF) and forced inspiratory flow at 50% of FVC. RESULTS A statistically significant difference between all spirometric parameters was found. Mean PEF and PIF, respectively, increased from 2.8 to 4.5 L/s (P < .0001) and 2.3 to 2.7 L/s (P < .01) before and after decannulation, with a strong positive correlation (r = 0.7; P < .05). A mean expiratory (34%) and inspiratory (9%) airflow reduction was observed due to cannula. CONCLUSIONS Occluded cuffless tracheostomy tubes cause a dramatic airflow obstruction, mainly in the expiratory phase of FVL. This should be taken into account during capping trials.
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Affiliation(s)
- Jose Antonio Sanchez-Guerrero
- Department of Rehabilitation, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France.,Department of Physiotherapy, University of Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Joanne Guerlain
- Department of Otolaryngology Head Neck Surgery, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France
| | - Maria Àngels Cebrià I Iranzo
- Department of Physical Therapy, University of Valencia and Hospital Universitarii Politecnic La Fe, Valencia, Spain
| | - Bertrand Baujat
- Department of Otolaryngology Head Neck Surgery, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France
| | - Jean Lacau St Guily
- Department of Otolaryngology Head Neck Surgery, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France.,Department of Otolaryngology Head Neck Surgery, Rothshild Fondation, Paris, France
| | - Sophie Périé
- Department of Otolaryngology Head Neck Surgery, Faculty of Medicine Sorbonne University, Hospital Tenon, Assistance Publique Hôpitaux Paris (APHP), Paris, France.,Department of Otolaryngology Head and Neck Surgery, COM CCF Maillot, Hartmann Clinic, Neuilly sur Seine, France
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Cough Effectiveness and Pulmonary Hygiene Practices in Patients with Pompe Disease. Lung 2018; 197:1-8. [PMID: 30361764 DOI: 10.1007/s00408-018-0171-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE While factors leading to hypoventilation have been well studied in Pompe disease, cough effectiveness and airway clearance practices are less understood. We aimed to identify significant factors that influence peak cough flow (PCF) in Pompe, and to detect whether pulmonary hygiene practices were reflective of reduced PCF. METHODS This is a prospective observational study of 20 subjects with Pompe disease (infantile-onset: 7, juvenile-onset: 6, adult-onset: 14). Subjects performed spirometry, maximal respiratory pressures, and cough (voluntary: n = 24, spontaneous: n = 3). Subjects or their parents reported airway clearance and secretion management practices. Relationships between disease variables, pulmonary function, and cough parameters as well as group differences in cough parameters were evaluated. RESULTS Subjects with infantile-onset disease had significantly lower PCF (p < 0.05) and tended to require more external ventilatory support (p = 0.07). In juvenile- and adult-onset disease, PCF differed according to external ventilatory requirement [daytime: 83.6 L/min (95% CI 41.2-126.0); nighttime: 224.6 L/min (95% CI 139.1-310.2); none: 340.2 L/min (95% CI 193.3-487.6), p < 0.005]. Cough inspiratory volume also differed significantly by ventilatory requirement [daytime: 5.5 mL/kg (95% CI 3.0-8.0); nighttime: 16.0 mL/kg (95% CI 11.8-20.2); none: 26.8 mL/kg (95% CI 11.9-41.7), p < 0.001]. However, routine airway clearance or secretion management practices were only consistently reported among patients with infantile-onset disease (infantile: 86%, juvenile: 0%, adult: 14%, p < 0.005). CONCLUSIONS Cough weakness was detected in the majority of patients with Pompe disease and was influenced by both inspiratory and expiratory muscle function. Patients at risk for problems or with ineffective PCF should be urged to complete routine pulmonary hygiene.
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Park MK, Lee SJ. Changes in Swallowing and Cough Functions Among Stroke Patients Before and After Tracheostomy Decannulation. Dysphagia 2018; 33:857-865. [PMID: 29915928 DOI: 10.1007/s00455-018-9920-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/14/2018] [Indexed: 11/26/2022]
Abstract
We investigated the functional changes in swallowing and voluntary coughing before and after tracheostomy decannulation among stroke patients who had undergone a tracheostomy. We also compared these functions between stroke patients who underwent tracheostomy tube removal and those who did not within 6 months of their stroke. Seventy-seven stroke patients who had undergone a tracheostomy were enrolled. All patients were evaluated by videofluoroscopic swallowing studies and a peak flow meter through the oral cavity serially until 6 months after their stroke. During the intensive rehabilitation period, if a patient satisfied the criteria for tracheostomy tube removal, the tube was removed. The patients were divided into the 'decannulated' group and the 'non-decannulated' group according to their tracheostomy tube removal status. In the decannulated group, swallowing function did not change before and after tracheostomy decannulation; however, cough function was significantly improved after decannulation. Although both groups exhibited functional improvement in swallowing and coughing over time, the improvement in the decannulated group was more significant than the improvement in the non-decannulated group. Our results revealed that stroke patients who had better functional improvement in swallowing and coughing were more likely to be potential candidates for tracheostomy decannulation. Stroke patients who recovered from neurogenic dysphagia, they were no longer affected by the mechanical effect of the tracheostomy tube on swallowing function. This study suggests that if patients show improvement in swallowing and coughing after their stroke, a multidisciplinary approach to tracheostomy decannulation would be needed to achieve better rehabilitation outcomes.
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Affiliation(s)
- Min Kyu Park
- Department of Pharmacology and Clinical Pharmacology, ChungBuk National University Hospital, Cheongju, 28644, Republic of Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation, Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, 34943, Republic of Korea.
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Terzi N, Lofaso F, Masson R, Beuret P, Normand H, Dumanowski E, Falaize L, Sauneuf B, Daubin C, Brunet J, Annane D, Parienti JJ, Orlikowski D. Physiological predictors of respiratory and cough assistance needs after extubation. Ann Intensive Care 2018; 8:18. [PMID: 29404723 PMCID: PMC5799095 DOI: 10.1186/s13613-018-0360-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 01/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Identifying patients at high risk of post-extubation acute respiratory failure requiring respiratory or mechanical cough assistance remains challenging. Here, our primary aim was to evaluate the accuracy of easily collected parameters obtained before or just after extubation in predicting the risk of post-extubation acute respiratory failure requiring, at best, noninvasive mechanical ventilation (NIV) and/or mechanical cough assistance and, at worst, reintubation after extubation.
Methods We conducted a multicenter prospective, open-label, observational study from April 2012 through April 2015. Patients who passed a weaning test after at least 72 h of endotracheal mechanical ventilation (MV) were included. Just before extubation, spirometry and maximal pressures were measured by a technician. The results were not disclosed to the bedside physicians. Patients were followed until discharge or death.
Results Among 3458 patients admitted to the ICU, 730 received endotracheal MV for longer than 72 h and were then extubated; among these, 130 were included. At inclusion, the 130 patients had mean ICU stay and endotracheal MV durations both equal to 11 ± 4.2 days. After extubation, 36 patients required curative NIV, 7 both curative NIV and mechanical cough assistance, and 8 only mechanical cough assistance; 6 patients, all of whom first received NIV, required reintubation within 48 h. The group that required NIV after extubation had a significantly higher proportion of patients with chronic respiratory disease (P = 0.015), longer endotracheal MV duration at inclusion, and lower Medical Research Council (MRC) score (P = 0.02, P = 0.01, and P = 0.004, respectively). By multivariate analysis, forced vital capacity (FVC) and peak cough expiratory flow (PCEF) were independently associated with (NIV) and/or mechanical cough assistance and/or reintubation after extubation. Areas under the ROC curves for pre-extubation PCEF and FVC were 0.71 and 0.76, respectively. Conclusion In conclusion, FVC measured before extubation correlates closely with FVC after extubation and may serve as an objective predictor of post-extubation respiratory failure requiring NIV and/or mechanical cough assistance and/or reintubation in heterogeneous populations of medical ICU patients. ClinicalTrials.gov as #NCT01564745 Electronic supplementary material The online version of this article (10.1186/s13613-018-0360-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicolas Terzi
- INSERM, Université Grenoble-Alpes, U1042, HP2, 38000, Grenoble, France. .,CHU Grenoble Alpes, Service de réanimation médicale, 38000, Grenoble, France. .,Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France.
| | - Frédéric Lofaso
- Université de Versailles Saint Quentin en Yvelines, INSERM U1179, Garches, France.,CIC 1429, INSERM, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.,Service d'Explorations Fonctionnelles Respiratoires, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France
| | - Romain Masson
- Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France
| | - Pascal Beuret
- Service de Réanimation, Centre Hospitalier de Roanne, 42300, Roanne, France
| | - Hervé Normand
- INSERM, U1075, 14000, Caen, France.,Université de Caen, 14000, Caen, France.,CHRU Caen, Service d'Explorations Fonctionnelles Respiratoire, 14000, Caen, France
| | - Edith Dumanowski
- CHRU Caen, Service d'Explorations Fonctionnelles Respiratoire, 14000, Caen, France
| | - Line Falaize
- INSERM U 1179, Université de Versailles-Saint Quentin en Yvelines, 104 Bd Raymond Poincaré, 92380, Garches, France.,CIC 1429, Inserm-APHP, Hôpital Raymond Poincaré, 104 Bd Raymond Poincaré, 92380, Garches, France
| | - Bertrand Sauneuf
- Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France.,Service de Réanimation Médicale Polyvalente, Centre Hospitalier Public du Cotentin, BP 208, 50102, Cherbourg-en-Cotentin, France
| | - Cédric Daubin
- Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France
| | - Jennifer Brunet
- Service de réanimation médicale, Centre Hospitalier Universitaire Grenoble - Alpes, CS10217, Grenoble Cedex 09, France
| | - Djillali Annane
- General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Laboratory of Inflammation and Infection, U1173, INSERM and University of Versailles SQY, 92380, Garches, France
| | - Jean-Jacques Parienti
- Unité de Biostatistique et de Recherche Clinique, Centre Hospitalier Universitaire de Caen, Avenue de la Côte de Nacre, 14033, Caen, France
| | - David Orlikowski
- Université de Versailles Saint Quentin en Yvelines, INSERM U1179, Garches, France.,CIC 1429, INSERM, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.,Pôle de ventilation à domicile, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France.,Service de Santé Publique, AP-HP, Hôpital Raymond Poincaré, 92380, Garches, France
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Sancho J, Servera E, Bañuls P, Marín J. Effectiveness of assisted and unassisted cough capacity in amyotrophic lateral sclerosis patients. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:498-504. [DOI: 10.1080/21678421.2017.1335324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jesús Sancho
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario,
- Research Group for Respiratory Problems in Neuromuscular Diseases, Institute of Health Research INCLIVA, and
| | - Emilio Servera
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario,
- Research Group for Respiratory Problems in Neuromuscular Diseases, Institute of Health Research INCLIVA, and
- Universitat de Valencia, Valencia, Spain
| | - Pilar Bañuls
- Respiratory Care Unit, Respiratory Medicine Department, Hospital Clínico Universitario,
- Research Group for Respiratory Problems in Neuromuscular Diseases, Institute of Health Research INCLIVA, and
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Kang SW, Choi WA, Won YH, Lee JW, Lee HY, Kim DJ. Clinical Implications of Assisted Peak Cough Flow Measured With an External Glottic Control Device for Tracheostomy Decannulation in Patients With Neuromuscular Diseases and Cervical Spinal Cord Injuries: A Pilot Study. Arch Phys Med Rehabil 2016; 97:1509-1514. [DOI: 10.1016/j.apmr.2016.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
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Winck JC, LeBlanc C, Soto JL, Plano F. Reply to "Misconceptions in the assessment of cough peak flow measurements for extubation or decanulation protocols". REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:286-7. [PMID: 26121944 DOI: 10.1016/j.rppnen.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- J C Winck
- Department of Pulmonology, Faculdade de Medicina, Universidade do Porto, Portugal; Linde Healthcare, Pullach, Germany.
| | - C LeBlanc
- Ottawa Hospital Rehabilitation Centre, Canada
| | - J L Soto
- REMEO(®) Centre el Pilar, Linde Group, Argentina
| | - F Plano
- REMEO(®) Centre el Pilar, Linde Group, Argentina
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The value of cough peak flow measurements in the assessment of extubation or decannulation readiness. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:94-8. [PMID: 25926373 DOI: 10.1016/j.rppnen.2014.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022] Open
Abstract
Insufficient cough strength has a major role in extubation and decannulation outcomes. Cough capacity can be easily evaluated by measuring flows during coughing. Values vary depending on whether cough flows are measured through the mouth or through a tracheostomy or endotracheal tube. It is important to standardize these measurements and start using them routinely in the extubation and decannulation processes. Values of cough peak flow >160 L/min measured at the mouth or a value of cough PEF >60 L/min measured at the endotracheal tube suggest successful decannulation or extubation.
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Brunet J, Dufour-Trivini M, Sauneuf B, Terzi N. Gestion de la décanulation : quelle prise en charge pour le patient trachéotomisé ? MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-014-1007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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