1
|
Gobert F, Yonis H, Tapponnier R, Fernandez R, Labaune MA, Burle JF, Barbier J, Vincent B, Cleyet M, Richard JC, Guérin C. Predicting Extubation Outcome by Cough Peak Flow Measured Using a Built-in Ventilator Flow Meter. Respir Care 2017; 62:1505-1519. [PMID: 28900041 DOI: 10.4187/respcare.05460] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Successful weaning from mechanical ventilation depends on the patient's ability to cough efficiently. Cough peak flow (CPF) could predict extubation success using a dedicated flow meter but required patient disconnection. We aimed to predict extubation outcome using an overall model, including cough performance assessed by a ventilator flow meter. METHODS This was a prospective observational study conducted from November 2014 to October 2015. Before and after a spontaneous breathing trial, subjects were encouraged to cough as strongly as possible before freezing the ventilator screen to assess CPF and tidal volume (VT) in the preceding inspiration. Early extubation success rate was defined as the proportion of subjects not re-intubated 48 h after extubation. Diagnostic performance of CPF and VT was assessed by using the area under the curve of the receiver operating characteristic curve. Cut-off values for CPF and VT were defined according to median values and used to describe the performance of a predictive test combining them with risk factors of early extubation failure. RESULTS Among 673 subjects admitted, 92 had a cough assessment before extubation. For the 81 subjects with early extubation success, the median CPF was -67.7 L/min, and median VT was 0.646 L. For the 11 subjects with early extubation failure, the median CPF was -57.3 L/min, and median VT was 0.448 L. Area under the curve was 0.61 (95% CI 0.37-0.83) for CPF and 0.64 (95% CI 0.42-0.84) for CPF/VT combined. After dichotomization (CPF < -60 L/min or VT > 0.55 L), there was a synergistic effect to predict early extubation success (P < .001). The predictive value of success reached 94.2% for CPF/VT combined. The overall model including pH before extubation < 7.45 reached a 66.7% predictive value of failure. CONCLUSIONS CPF measured using the flow meter of an ICU ventilator was able to predict extubation success and to build a composite score to predict extubation failure. The results were close to that found in previous studies that used a dedicated flow meter. This could help to identify high-risk subjects to prevent extubation failure. (ClinicalTrials.gov registration NCT02847221.).
Collapse
Affiliation(s)
- Florent Gobert
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France. .,Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Hodane Yonis
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Romain Tapponnier
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Raul Fernandez
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Marie-Aude Labaune
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Jean-François Burle
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Jack Barbier
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Bernard Vincent
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Maria Cleyet
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France
| | - Jean-Christophe Richard
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Claude Guérin
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service de Réanimation Médicale, Lyon, France.,Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.,INSERM 955 Equipe 13, Créteil, France
| |
Collapse
|