Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Yuzhong District, Chongqing, 400016, China.
Department of Geriatric Respiratory, People's Hospital of Wenjiang District, Kangtai Road 86, Wenjiang District, Chengdu, Sichuan Province, 611130, China.
Crit Care. 2021 Oct 12;25(1):357. doi: 10.1186/s13054-021-03781-5.
The predictive power of extubation failure diagnosed by cough strength varies by study. Here we summarise the diagnostic power of extubation failure tested by cough strength.
A comprehensive online search was performed to select potentially eligible studies that evaluated the predictive power of extubation failure tested by cough strength. A manual search was also performed to identify additional studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the predictive power of extubation failure.
A total of 34 studies involving 45 study arms were enrolled, and 7329 patients involving 8684 tests were analysed. In all, 23 study arms involving 3018 tests measured cough peak flow before extubation. The pooled extubation failure was 36.2% and 6.3% in patients with weak and strong cough assessed by cough peak flow, respectively. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.76 (95% confidence interval [CI]: 0.72-0.80), 0.75 (0.69-0.81), 2.89 (2.36-3.54), 0.37 (0.30-0.45), 8.91 (5.96-13.32), and 0.79 (0.75-0.82), respectively. Moreover, 22 study arms involving 5666 tests measured the semiquantitative cough strength score (SCSS) before extubation. The pooled extubation failure was 37.1% and 11.3%, respectively, in patients with weak and strong cough assessed by the SCSS. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.53 (95% CI: 0.41-0.64), 0.83 (0.74-0.89), 2.50 (1.93-3.25), 0.65 (0.56-0.76), 4.61 (3.03-7.01), and 0.74 (0.70-0.78), respectively.
Weak cough is associated with increased extubation failure. Cough peak flow is superior to the SCSS for predicting extubation failure. However, both show moderate power for predicting extubation failure.
咳嗽力度诊断的拔管失败预测能力因研究而异。在这里，我们总结了通过咳嗽力度测试的拔管失败的诊断能力。
全面的在线搜索用于选择评估通过咳嗽力度测试的拔管失败预测能力的潜在合格研究。还进行了手动搜索以确定其他研究。提取数据以计算汇总的敏感性、特异性、阳性似然比 (LR)、阴性 LR、诊断比值比 (DOR) 和受试者工作特征曲线下的面积 (AUC)，以评估拔管失败的预测能力。
共纳入 34 项研究共 45 个研究臂，共分析了 7329 名患者的 8684 次检测。共有 23 个研究臂共 3018 次检测在拔管前测量了咳嗽峰流速。咳嗽峰流速评估的弱咳嗽和强咳嗽患者的总体拔管失败率分别为 36.2%和 6.3%。汇总的敏感性、特异性、阳性 LR、阴性 LR、DOR 和 AUC 分别为 0.76(95%置信区间[CI]：0.72-0.80)、0.75(0.69-0.81)、2.89(2.36-3.54)、0.37(0.30-0.45)、8.91(5.96-13.32)和 0.79(0.75-0.82)。此外，22 个研究臂共 5666 次检测在拔管前测量了半定量咳嗽强度评分 (SCSS)。SCSS 评估的弱咳嗽和强咳嗽患者的总体拔管失败率分别为 37.1%和 11.3%。汇总的敏感性、特异性、阳性 LR、阴性 LR、DOR 和 AUC 分别为 0.53(95% CI：0.41-0.64)、0.83(0.74-0.89)、2.50(1.93-3.25)、0.65(0.56-0.76)、4.61(3.03-7.01)和 0.74(0.70-0.78)。
弱咳嗽与拔管失败风险增加相关。咳嗽峰流速优于 SCSS 用于预测拔管失败。然而，两者均具有中等预测拔管失败的能力。
