Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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

Pico de fluxo de tosse reflexa como preditor de sucesso na extubação em pacientes neurológicos

Fernanda Machado Kutchak1,2, Andressa Maciel Debesaitys2, Marcelo de Mello Rieder2,3, Carla Meneguzzi2, Amanda Soares Skueresky3, Luiz Alberto Forgiarini Junior3,4, Marino Muxfeldt Bianchin5

J Bras Pneumol.2015;41(4):358-364

Abstract PDF PT PDF EN Portuguese Text

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.

 


Keywords: Weaning; Intensive care units; Cough.

 


Simple motor tasks independently predict extubation failure in critically ill neurological patients

Tarefas motoras simples predizem independentemente a falha de extubação em pacientes neurológicos críticos

Fernanda Machado Kutchak1,2,3,4, Marcelo de Mello Rieder1,2,4, Josué Almeida Victorino1,4, Carla Meneguzzi4, Karla Poersch3, Luiz Alberto Forgiarini Junior5, Marino Muxfeldt Bianchin1,2,6

J Bras Pneumol.2017;43(3):183-189

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the usefulness of simple motor tasks such as hand grasping and tongue protrusion as predictors of extubation failure in critically ill neurological patients. Methods: This was a prospective cohort study conducted in the neurological ICU of a tertiary care hospital in the city of Porto Alegre, Brazil. Adult patients who had been intubated for neurological reasons and were eligible for weaning were included in the study. The ability of patients to perform simple motor tasks such as hand grasping and tongue protrusion was evaluated as a predictor of extubation failure. Data regarding duration of mechanical ventilation, length of ICU stay, length of hospital stay, mortality, and incidence of ventilator-associated pneumonia were collected. Results: A total of 132 intubated patients who had been receiving mechanical ventilation for at least 24 h and who passed a spontaneous breathing trial were included in the analysis. Logistic regression showed that patient inability to grasp the hand of the examiner (relative risk = 1.57; 95% CI: 1.01-2.44; p < 0.045) and protrude the tongue (relative risk = 6.84; 95% CI: 2.49-18.8; p < 0.001) were independent risk factors for extubation failure. Acute Physiology and Chronic Health Evaluation II scores (p = 0.02), Glasgow Coma Scale scores at extubation (p < 0.001), eye opening response (p = 0.001), MIP (p < 0.001), MEP (p = 0.006), and the rapid shallow breathing index (p = 0.03) were significantly different between the failed extubation and successful extubation groups. Conclusions: The inability to follow simple motor commands is predictive of extubation failure in critically ill neurological patients. Hand grasping and tongue protrusion on command might be quick and easy bedside tests to identify neurocritical care patients who are candidates for extubation.

 


Keywords: Ventilator weaning; Airway extubation/adverse effects; Critical care; Neurosurgery.

 


 

 


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CNPq, Capes, Ministério da Educação, Ministério da Ciência e Tecnologia, Governo Federal, Brasil, País Rico é País sem Pobreza
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E-mails: jbp@jbp.org.br
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