Hospital Nacional Profesor Alejandro Posadas - Buenos Aires, Argentina.
Crit Care Sci. 2023 Mar 1;35(1):37-43. doi: 10.5935/2965-2774.20230275-en.
To compare the diagnostic performance of maximal expiratory pressure with maximal expiratory pressure during induced cough for predicting extubation failure within 72 hours in patients who completed a spontaneous breathing trial (SBT).
The study was conducted between October 2018 and September 2019. All patients aged over 18 years admitted to the intensive care unit who required invasive mechanical ventilation for over 48 hours and successfully completed a spontaneous breathing trial were included. The maximal expiratory pressure was assessed with a unidirectional valve for 40 seconds, and verbal encouragement was given. The maximal expiratory pressure during induced cough was measured with slow instillation of 2mL of a 0.9% saline solution. The primary outcome variable was extubation failure.
Eighty patients were included, of which 43 (54%) were male. Twenty-two patients [27.5% (95%CI 18.9 - 38.1)] failed extubation within 72 hours. Differences were observed in the maximal expiratory pressure during induced cough between the group who failed extubation, with a median of 0cmH2O (P25-75: 0 - 90), and the group without extubation failure, with a median of 120cmH2O (P25-75: 73 - 120); p < 0.001.
In patients who completed a spontaneous breathing trial, the maximal expiratory pressure during induced cough had a higher diagnostic performance for predicting extubation failure within 72 hours.Clinicaltrials.gov Registry: NCT04356625.
比较最大呼气压力与诱导咳嗽时的最大呼气压力在预测完成自主呼吸试验（SBT）的患者 72 小时内拔管失败的诊断性能。
本研究于 2018 年 10 月至 2019 年 9 月进行。所有年龄超过 18 岁、因需要机械通气超过 48 小时而入住重症监护病房、成功完成自主呼吸试验的患者均纳入研究。采用单向阀进行 40 秒的最大呼气压力评估，并给予口头鼓励。用 2ml 0.9%生理盐水进行缓慢滴注以测量诱导咳嗽时的最大呼气压力。主要结局变量为拔管失败。
共纳入 80 例患者，其中 43 例（54%）为男性。22 例患者（27.5%（95%CI 18.9 - 38.1））在 72 小时内拔管失败。在 72 小时内发生拔管失败的患者与未发生拔管失败的患者之间，诱导咳嗽时的最大呼气压力存在差异，中位数分别为 0cmH2O（P25-75：0 - 90）和 120cmH2O（P25-75：73 - 120）；p < 0.001。
在完成自主呼吸试验的患者中，诱导咳嗽时的最大呼气压力对预测 72 小时内拔管失败具有更高的诊断性能。
Clinicaltrials.gov 注册号：NCT04356625。
