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. 2015 Jul-Aug;41(4):358-64.
doi: 10.1590/S1806-37132015000004453.

Reflex cough PEF as a predictor of successful extubation in neurological patients

[Article in English, Portuguese]
Fernanda Machado Kutchak  1 , Andressa Maciel Debesaitys  2 , Marcelo de Mello Rieder  2 , Carla Meneguzzi  2 , Amanda Soares Skueresky  3 , Luiz Alberto Forgiarini Junior  3 , Marino Muxfeldt Bianchin  4
Affiliations

Reflex cough PEF as a predictor of successful extubation in neurological patients

[Article in English, Portuguese]
Fernanda Machado Kutchak et al. J Bras Pneumol. 2015 Jul-Aug.

Abstract
in English, Portuguese

Objective: To evaluate the use of reflex cough PEF as a predictor of successful extubation in neurological patients who were candidates for weaning from mechanical ventilation.

Methods: This was a cross-sectional study of 135 patients receiving mechanical ventilation for more than 24 h in the ICU of Cristo Redentor Hospital, in the city of Porto Alegre, Brazil. Reflex cough PEF, the rapid shallow breathing index, MIP, and MEP were measured, as were ventilatory, hemodynamic, and clinical parameters.

Results: The mean age of the patients was 47.8 ± 17 years. The extubation failure rate was 33.3%. A reflex cough PEF of < 80 L/min showed a relative risk of 3.6 (95% CI: 2.0-6.7), and the final Glasgow Coma Scale score showed a relative risk of 0.64 (95% CI: 0.51-0.83). For every 1-point increase in a Glasgow Coma Scale score of 8, there was a 36% reduction in the risk of extubation failure.

Conclusions: Reflex cough PEF and the Glasgow Coma Scale score are independent predictors of extubation failure in neurological patients admitted to the ICU.

Objetivo:: Avaliar o uso do pico de fluxo de tosse reflexa (PFTR) como preditor do sucesso da extubação de pacientes neurológicos candidatos a desmame da ventilação mecânica.

Métodos:: Estudo transversal com 135 pacientes ventilados mecanicamente por mais de 24 h na UTI do Hospital Cristo Redentor, em Porto Alegre (RS). Foram medidos o PFTR, o índice de respiração rápida e superficial, a PImáx e a PEmáx, bem como parâmetros ventilatórios, hemodinâmicos e clínicos.

Resultados:: A média de idade dos pacientes foi de 47,8 ± 17 anos. A taxa de insucesso na extubação foi de 33,3%. O PFTR &lt; 80 l/min apresentou risco relativo de 3,6 (IC95%: 2,0-6,7), e a pontuação final na Escala de Coma de Glasgow apresentou risco relativo de 0,64 (IC95%: 0,51-0,83). A partir de 8 pontos, cada aumento de 1 ponto diminuiu em 36% o risco de insucesso na extubação.

Conclusões:: O PFTR e a pontuação na Escala de Coma de Glasgow são preditores independentes de falha na extubação em pacientes neurológicos internados na UTI.

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Figures

Figure 1
Figure 1. Accuracy of reflex cough PEF and Glasgow Coma Scale scores in predicting successful extubation in neurological patients admitted to the ICU.
Figura 1
Figura 1. Acurácia do pico de fluxo de tosse reflexa e da pontuação na Escala de Coma de Glasgow como preditores do sucesso da extubação de pacientes neurológicos internados na UTI.
See this image and copyright information in PMC

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