The effects of mechanical cough assist on rate of reintubation in patients with ineffective cough,a preliminary analysis

Abstract

Background: Ineffective cough is a common cause of extubation failure. Mechanical insufflation/exsufflation(MI-E) is an airway clearance device improving cough efficacy. However, data of using MI-E in weaning patients were limited.

Methods: We conducted a RCT to determine the efficacy of MI-E to reduce reintubation during a postextubation period. Patients assisted with MV for > 48 hours who passed SBT but impaired cough strength were enrolled. The patients were randomized to control group or MI-E group. The airway clearance procedure with MI-E was applied in MI-E group during the 48-hour postextubation period. Both groups received the same standard care. The primary outcome was the reintubation rate in 48 hours after extubation and the secondary outcomes were oxygenation improvement, cough peak flow(CPF) changes, NIV uses and adverse events during the 48-hour period.

Results: Totally, 43 patients were enrolled; 22 in MI-E group and 21 in control group. There was 1 patient in MI-E group reintubated due to volume overload. The MI-E group tended to have better oxygen improvement between 24 and 48 hours after extubation with PF ratio difference of 20(68.4) mmHg in MI-E group VS 0.74(53.87) mmHg in control group, p= 0.312). No deoxygenation, NIV rescue, NIV failure or adverse events appeared in both groups. CPF tended to increase in MI-E group (the difference of CPF 6.82(14.27) LPM in MI-E group and -0.48(42.36) LPM in control group, p= 0.449).

Conclusions: The cough assist procedure during the postextubation period did not prevent reintubation but might improve oxygenation and cough strength during the 48-hour postextubation period without increased adverse events.