Almeida Christiane Melo, Lopes Agnaldo José, Guimarães Fernando Silva
Rehabilitation Sciences Post-Graduation Program, Augusto Motta University, Rio de Janeiro, Brazil.
Post-Graduation Program in Medical Sciences, School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
Can J Respir Ther. 2020 Nov 20;56:58-64. doi: 10.29390/cjrt-2020-037. eCollection 2020.
The purpose of this study was to compare the predictive value of three cough peak flow (CPF) maneuvers in predicting the extubation outcome in a cohort of mechanically ventilated subjects.
Eighty-one mechanically ventilated subjects who succeeded in the spontaneous breathing trial were included. In a randomized order, CPF was stimulated and measured using three methods: voluntary command (V_CPF), tracheal saline instillation (S_CPF), and mechanical stimulation with a catheter (C_CPF). Additionally, CPF was measured 20 min after the extubation (PE_CPF). The diagnostic accuracy of the CPF methods in relation to the extubation outcome was measured using the receiver operating characteristic (ROC) curve. ROC curve results were compared using the Hanley and McNeil method.
The three methods presented high accuracy in predicting the extubation outcome (V_CPF = 0.89, S_CPF = 0.93, and C_CPF = 0.90), without statistically significant differences between them (V_CPF vs. S_CPF, = 0.14; V_CPF vs. C_CPF, = 0.84; S_CPF vs. C_CPF, = 0.13). The optimum cutoff values were V_CPF = 45 L/min, S_CPF = 60 L/min, and C_CPF = 55 L/min. PE_CPF also showed high accuracy in predicting the extubation outcome (AUC = 0.95; cutoff = 75 L/min).
In mechanically ventilated and cooperative subjects, there is no difference in the accuracy of CPF measured voluntarily, with stimulation using saline or by catheter stimulation in predicting the reintubation. CPF recording after endotracheal tube removal has high accuracy to predict the extubation outcome.
本研究旨在比较三种咳嗽峰流速（CPF）操作在预测一组机械通气患者拔管结果方面的预测价值。
纳入81例成功完成自主呼吸试验的机械通气患者。采用随机顺序，通过三种方法刺激并测量CPF：自主指令（V_CPF）、气管内滴注生理盐水（S_CPF）和用导管进行机械刺激（C_CPF）。此外，在拔管后20分钟测量CPF（PE_CPF）。使用受试者工作特征（ROC）曲线测量CPF方法与拔管结果相关的诊断准确性。采用Hanley和McNeil方法比较ROC曲线结果。
三种方法在预测拔管结果方面均具有较高的准确性（V_CPF = 0.89，S_CPF = 0.93，C_CPF = 0.90），它们之间无统计学显著差异（V_CPF与S_CPF比较，P = 0.14；V_CPF与C_CPF比较，P = 0.84；S_CPF与C_CPF比较，P = 0.13）。最佳截断值分别为V_CPF = 45升/分钟，S_CPF = 60升/分钟，C_CPF = 55升/分钟。PE_CPF在预测拔管结果方面也显示出较高的准确性（AUC = 0.95；截断值 = 75升/分钟）。
在机械通气且配合良好的患者中，自主测量的CPF、使用生理盐水刺激或导管刺激测量的CPF在预测再次插管方面的准确性无差异。气管插管拔除后记录的CPF对预测拔管结果具有较高的准确性。
