Smina Mihai, Salam Adil, Khamiees Mohammad, Gada Pritee, Amoateng-Adjepong Yaw, Manthous Constantine A
Pulmonary and Critical Care, Bridgeport Hospital and Yale University School of Medicine, Bridgeport, CT 06610, USA.
Chest. 2003 Jul;124(1):262-8. doi: 10.1378/chest.124.1.262.
Semiobjective methods of quantifying cough strength and endotracheal secretions have been demonstrated to predict extubation outcomes of patients who have passed a spontaneous breathing trial (SBT).
Cough strength, measured by voluntary cough peak expiratory flow (PEF), and endotracheal secretions, measured volumetrically, predict extubation outcomes of patients who have passed an SBT.
Critically ill patients admitted to the medical ICU of a 300-bed community teaching hospital.
All patients who passed an SBT and were about to be extubated were studied. The best of three cough attempts, measured with an in-line spirometer, and the average hourly rate of suctioned secretions prior to extubation were recorded with other weaning parameters and demographic data.
Ninety-five patients were studied before and after 115 extubations. There were 13 unsuccessful extubations. There were no differences in age, gender, duration of intubation, or APACHE (acute physiology and chronic health evaluation) II scores between successful and unsuccessful extubations. The magnitude of endotracheal secretions was not associated with outcomes. The PEF of patients with unsuccessful extubations was significantly lower than that of those with successful extubations (64.2 +/- 6.8 L/min vs 81.9 +/- 2.7 L/min, p = 0.03). Patients with unsuccessful extubations stayed longer in the ICU than those with successful extubations (11.7 +/- 2.1 days vs 5.3 +/- 0.4 days, p = 0.009). Those with PEF <or= 60 L/min were five times as likely to have unsuccessful extubations and were 19 times as likely to die on that hospital stay. PEF and the rapid shallow breathing index were independently associated with extubation outcomes, while only the PEF (<or= 60 L/min) was independently associated with in-hospital mortality.
These data suggest that cough strength, measured objectively, is a predictor of extubation outcome, morbidity, and mortality.
已证实，用于量化咳嗽强度和气管内分泌物的半客观方法可预测通过自主呼吸试验（SBT）的患者的拔管结果。
通过自主咳嗽呼气峰值流速（PEF）测量的咳嗽强度和通过容量测量的气管内分泌物可预测通过SBT的患者的拔管结果。
入住一家拥有300张床位的社区教学医院内科重症监护病房（ICU）的重症患者。
对所有通过SBT且即将拔管的患者进行研究。使用在线肺活量计测量三次咳嗽尝试中的最佳值，并记录拔管前每小时吸引分泌物的平均速率以及其他撤机参数和人口统计学数据。
对95例患者在115次拔管前后进行了研究。有13次拔管未成功。成功拔管和未成功拔管的患者在年龄、性别、插管持续时间或急性生理与慢性健康状况评估（APACHE）II评分方面无差异。气管内分泌物的量与结果无关。未成功拔管患者的PEF显著低于成功拔管患者（64.2±6.8升/分钟对81.9±2.7升/分钟，p = 0.03）。未成功拔管的患者在ICU的停留时间比成功拔管的患者更长（11.7±2.1天对5.3±0.4天，p = 0.009）。PEF≤60升/分钟的患者拔管未成功的可能性是其他患者的5倍，在该住院期间死亡的可能性是其他患者的19倍。PEF和快速浅呼吸指数与拔管结果独立相关，而只有PEF（≤60升/分钟）与住院死亡率独立相关。
这些数据表明，客观测量的咳嗽强度是拔管结果、发病率和死亡率的预测指标。
