PDF(Pubmed)
Abstract：
BACKGROUND: No objective indicator exists for evaluating cough strength during extubation of tracheally intubated patients. This study aimed to determine whether cough peak expiratory flow (CPEF) can predict the risk of reintubation due to decreased cough strength.
METHODS: This was a retrospective cohort study of patients who were admitted to our Emergency Intensive Care Unit between September 1, 2020 and August 31, 2021 and were under artificial ventilation management for ≥ 24 h. The patients were divided into two groups: successful extubation and reintubation groups, and the relationship between CPEF immediately before extubation and reintubation was investigated.
RESULTS: Seventy-six patients were analyzed. In the univariate analysis, CPEF was significantly different between the successful extubation (90.7 ± 25.9 L/min) and reintubation (57.2 ± 6.4 L/min) groups (p < 0.001). In the multivariate analysis with age and duration of artificial ventilation as covariates, CPEF was significantly lower in the reintubation group (p < 0.01). The cutoff value of CPEF for reintubation according to the receiver operating characteristic curve was 60 L/min (area under the curve, 0.897; sensitivity, 78.5%; specificity, 90.9%; p < 0.01).
CONCLUSIONS: CPEF in tracheally intubated patients may be a useful indicator for predicting the risk of reintubation associated with decreased cough strength. The cutoff CPEF value for reintubation due to decreased cough strength was 60 L/min.
METHODS: This was a retrospective cohort study of patients who were admitted to our Emergency Intensive Care Unit between September 1, 2020 and August 31, 2021 and were under artificial ventilation management for ≥ 24 h. The patients were divided into two groups: successful extubation and reintubation groups, and the relationship between CPEF immediately before extubation and reintubation was investigated.
RESULTS: Seventy-six patients were analyzed. In the univariate analysis, CPEF was significantly different between the successful extubation (90.7 ± 25.9 L/min) and reintubation (57.2 ± 6.4 L/min) groups (p < 0.001). In the multivariate analysis with age and duration of artificial ventilation as covariates, CPEF was significantly lower in the reintubation group (p < 0.01). The cutoff value of CPEF for reintubation according to the receiver operating characteristic curve was 60 L/min (area under the curve, 0.897; sensitivity, 78.5%; specificity, 90.9%; p < 0.01).
CONCLUSIONS: CPEF in tracheally intubated patients may be a useful indicator for predicting the risk of reintubation associated with decreased cough strength. The cutoff CPEF value for reintubation due to decreased cough strength was 60 L/min.
摘要：
背景：没有客观指标来评估气管插管患者拔管期间的咳嗽强度。这项研究旨在确定咳嗽峰值呼气流量（CPEF）是否可以预测由于咳嗽强度降低而重新插管的风险。
方法：这是一项回顾性队列研究，研究对象是2020年9月1日至2021年8月31日期间入住急诊重症监护病房并接受人工通气管理≥24h的患者。患者分为两组：成功拔管组和重新插管组，探讨拔管前CPEF与再插管前CPEF的关系。
结果：分析76例患者。在单变量分析中，成功拔管组(90.7±25.9L/min)和再插管组(57.2±6.4L/min)之间的CPEF差异有统计学意义(p<0.001)。在以年龄和人工通气持续时间为协变量的多变量分析中，再插管组CPEF明显降低(p<0.01)。根据受试者工作特性曲线，再插管的CPEF截止值为60L/min（曲线下面积，0.897；灵敏度，78.5%；特异性，90.9%；p<0.01)。
结论：气管插管患者的CPEF可能是预测与咳嗽强度降低相关的再插管风险的有用指标。由于咳嗽强度降低而重新插管的截止CPEF值为60L/min。
方法：这是一项回顾性队列研究，研究对象是2020年9月1日至2021年8月31日期间入住急诊重症监护病房并接受人工通气管理≥24h的患者。患者分为两组：成功拔管组和重新插管组，探讨拔管前CPEF与再插管前CPEF的关系。
结果：分析76例患者。在单变量分析中，成功拔管组(90.7±25.9L/min)和再插管组(57.2±6.4L/min)之间的CPEF差异有统计学意义(p<0.001)。在以年龄和人工通气持续时间为协变量的多变量分析中，再插管组CPEF明显降低(p<0.01)。根据受试者工作特性曲线，再插管的CPEF截止值为60L/min（曲线下面积，0.897；灵敏度，78.5%；特异性，90.9%；p<0.01)。
结论：气管插管患者的CPEF可能是预测与咳嗽强度降低相关的再插管风险的有用指标。由于咳嗽强度降低而重新插管的截止CPEF值为60L/min。
