RT Journal Article
SR Electronic
T1 A new method to measure cough pressure in intubated patients. Validity and usefulness as a predictor of extubation failure in ICU patients having succeded a spontaneous breathing trial
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P4928
VO 42
IS Suppl 57
A1 Baz, Manuel
A1 Echavarria, Estrella
A1 Alzugaray, Pedro
A1 Biestro, Alberto
A1 Cancela, Mario
A1 Cabrera, Julio
YR 2013
UL https://publications.ersnet.org//content/42/Suppl_57/P4928.abstract
AB We aimed to validate a new equipment and method to measure cough pressure developed at the tube cuff as a predictor of successful extubation in a Burn ICU. Methods: once extubation criteria met and a spontaneous breathing trial succeded, we measured: cough pressure with a new device (mmHg)(CPd), cough pressure with a commercial handheld dynamometry (mmHg)(CPhhd), and used a BICORE to measure Cough Peak Flow (L/sec)(CpF), Maximal Inspiratory Pressure (mmHg)(MIP), Tidal Volume (mL)(Vt), Respiratory Rate (RR). Extubation failure expressed the reintubation within the 48 hours. We measured morphine dose 4 hours prior extubation and clinical characteristics. T test (Bonferroni corrected), Pearson correlation, Bland Altmann agreement and multiple regression analysis were used.Results: We studied 40 patients, 39,5 ± 25,7 years old. Admission criteria: inhalation injury in 38 cases and polyvalent disease in 2 cases. 4 patients failed extubation (10%). CPd vs CPhhd comparaison showed a significant correlation (r=0,91) and a Bland – Altmann plot analysis of the differences showed significant agreement. CPd and CPF showed a significant correlation. Patients succeded vs failed showed: Ve 2.9 ± 0.99 vs 2.4 ± 0.28 (*), CPF 1.47 ± 0.13 vs 1.23 ± 0.15 (*), MIP 38.2 ± 3.36 vs 31.0 ± 2.94 (*). CPd 54.5 ± 9.3 vs 23.0 ± 3.5 (*). CPd best related to extubation success (*). Dose of morphine (mg) was 1,20 ± 0,77 vs 2,60 ± 0,66 (*). (*) means p minor 0,05.Conclusions: We could perform and validate the method, and CPd was the best extubation success predictor. A hypodynamic scenario was due to sedative agents.