Top

Published in:

Open Access 01-12-2018 | Research

Increase in intra-abdominal pressure during airway suctioning-induced cough after a successful spontaneous breathing trial is associated with extubation outcome

Authors: Yasuhiro Norisue, Jun Kataoka, Yosuke Homma, Takaki Naito, Junpei Tsukuda, Kentaro Okamoto, Takeshi Kawaguchi, Lonny Ashworth, Shimada Yumiko, Yuiko Hoshina, Eiji Hiraoka, Shigeki Fujitani

Published in: Annals of Intensive Care | Issue 1/2018

Abstract

Background

A patient’s ability to clear secretions and protect the airway with an effective cough is an important part of the pre-extubation evaluation. An increase in intra-abdominal pressure (IAP) is important in generating the flow rate necessary for a cough. This study investigated whether an increase from baseline in IAP during a coughing episode induced by routine pre-extubation airway suctioning is associated with extubation outcome after a successful spontaneous breathing trial (SBT).

Methods

Three hundred thirty-five (335) mechanically ventilated patients who passed an SBT were enrolled. Baseline IAP and peak IAP during successive suctioning-induced coughs were measured with a fluid column connected to a Foley catheter.

Results

Extubation was unsuccessful in 24 patients (7.2%). Unsuccessful extubation was 3.40 times as likely for patients with a delta IAP (ΔIAP) of ≤ 30 cm H₂O than for those with a ΔIAP > 30 cm H₂O, after adjusting for APACHE II score (95% CI, 1.39–8.26; p = .007).

Conclusion

ΔIAP during a coughing episode induced by routine pre-extubation airway suctioning is significantly associated with extubation outcome in patients with a successful SBT.

Trial registration UMIN-CTR Clinical Trial, UMIN000017762. Registered 1 June 2015.

Wang ZY, Bai Y. Cough-another important factor in extubation readiness in critically ill patients. Crit Care. 2012;16(6):461.PubMedPubMedCentral

Jiang C, Esquinas A, Mina B. Evaluation of cough peak expiratory flow as a predictor of successful mechanical ventilation discontinuation: a narrative review of the literature. J Intensive Care. 2017;5:33.CrossRefPubMedPubMedCentral

Krinsley JS, Reddy PK, Iqbal A. What is the optimal rate of failed extubation? Crit Care. 2012;16(1):111.CrossRefPubMedPubMedCentral

Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest. 2001;120(4):1262–70.CrossRefPubMed

Smina M, Salam A, Khamiees M, Gada P, Amoateng-Adjepong Y, Manthous CA. Cough peak flows and extubation outcomes. Chest. 2003;124(1):262–8.CrossRefPubMed

Duan J, Liu J, Xiao M, Yang X, Wu J, Zhou L. Voluntary is better than involuntary cough peak flow for predicting re-intubation after scheduled extubation in cooperative subjects. Respir Care. 2014;59(11):1643–51.CrossRefPubMed

Bai L, Duan J. Use of cough peak flow measured by a ventilator to predict re-intubation when a spirometer is unavailable. Respir Care. 2017;62(5):566–71.CrossRefPubMed

Beuret P, Roux C, Auclair A, Nourdine K, Kaaki M, Carton MJ. Interest of an objective evaluation of cough during weaning from mechanical ventilation. Intensive Care Med. 2009;35(6):1090–3.CrossRefPubMed

Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous CA. Neurologic status, cough, secretions and extubation outcomes. Intensive Care Med. 2004;30(7):1334–9.CrossRefPubMed

10.

Su WL, Chen YH, Chen CW, Yang SH, Su CL, Perng WC, Wu CP, Chen JH. Involuntary cough strength and extubation outcomes for patients in an ICU. Chest. 2010;137(4):777–82.CrossRefPubMed

11.

Grelot L, Milano S. Diaphragmatic and abdominal muscle activity during coughing in the decerebrate cat. NeuroReport. 1991;2(4):165–8.CrossRefPubMed

12.

McCool FD. Global physiology and pathophysiology of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):48S–53S.CrossRefPubMed

13.

Irwin RS, Rosen MJ, Braman SS. Cough. A comprehensive review. Arch Intern Med. 1977;137(9):1186–91.CrossRefPubMed

14.

Addington WR, Stephens RE, Phelipa MM, Widdicombe JG, Ockey RR. Intra-abdominal pressures during voluntary and reflex cough. Cough. 2008;4:2.CrossRefPubMedPubMedCentral

15.

Luginbuehl H, Baeyens JP, Kuhn A, Christen R, Oberli B, Eichelberger P, Radlinger L. Pelvic floor muscle reflex activity during coughing—an exploratory and reliability study. Ann Phys Rehabil Med. 2016;59(5–6):302–7.CrossRefPubMed

16.

Stephens RE, Addington WR, Miller SP, Anderson JW. Videofluoroscopy of the diaphragm during voluntary and reflex cough in humans. Am J Phys Med Rehabil. 2003;82(5):384.PubMed

17.

Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med. 2006;32(11):1722–32.CrossRefPubMed

18.

Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–9.CrossRefPubMed

19.

Epstein SK. Decision to extubate. Intensive Care Med. 2002;28(5):535–46.CrossRefPubMed

20.

Korpáš J. Tomori Zn: cough and other respiratory reflexes. Basel: S. Karger; 1979.

21.

Tatar M, Hanacek J, Widdicombe J. The expiration reflex from the trachea and bronchi. Eur Respir J. 2008;31(2):385–90.CrossRefPubMed

22.

Widdicombe J, Fontana G. Cough: what’s in a name? Eur Respir J. 2006;28(1):10–5.CrossRefPubMed

23.

Hermans G, Van den Berghe G. Clinical review: intensive care unit acquired weakness. Crit Care. 2015;19:274.CrossRefPubMedPubMedCentral

Title: Increase in intra-abdominal pressure during airway suctioning-induced cough after a successful spontaneous breathing trial is associated with extubation outcome
Authors: Yasuhiro Norisue
Jun Kataoka
Yosuke Homma
Takaki Naito
Junpei Tsukuda
Kentaro Okamoto
Takeshi Kawaguchi
Lonny Ashworth
Shimada Yumiko
Yuiko Hoshina
Eiji Hiraoka
Shigeki Fujitani
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: Annals of Intensive Care / Issue 1/2018
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-018-0410-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Increase in intra-abdominal pressure during airway suctioning-induced cough after a successful spontaneous breathing trial is associated with extubation outcome

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Response to different furosemide doses predicts AKI progression in ICU patients with elevated plasma NGAL levels

The effect of multidisciplinary extracorporeal membrane oxygenation team on clinical outcomes in patients with severe acute respiratory failure

Evaluation of emotional excitation during standardized endotracheal intubation in simulated conditions

Stool cultures at the ICU: get rid of it!

Potentially modifiable respiratory variables contributing to outcome in ICU patients without ARDS: a secondary analysis of PRoVENT

Sustained low efficiency dialysis should not be interrupted for performing transpulmonary thermodilution measurements