The predictive power of extubation failure diagnosed by cough strength varies by study. Researchers have conducted a meta-analysis to summarise the diagnostic power of extubation failure tested by cough strength.
Researchers have found that a weak cough is associated with increased extubation failure. It can be assessed by cough peak flow and the semiquantitative cough strength score (SCSS).
Weak cough is associated with failure of extubation. Cough peak flow may be used to determine it. In certain trials, patients who successfully extubated had a greater cough peak flow than those who did not. However, another research found no difference in cough peak flow between patients who successfully underwent extubation and those who did not. Additionally, the semiquantitative cough strength score (SCSS) may be used to assess cough strength. Given the conflicting findings of various studies and the use of numerous methodologies to quantify cough strength, we conducted a systematic review of the literature and a meta-analysis to determine the usefulness of diagnostic tools that employ cough strength to identify extubation failure early.
The present analysis conducted a thorough internet search to identify possibly qualifying studies that assessed the predictive capacity of extubation failure as measured by cough intensity. Additionally, a manual search was used to locate other research. To assess the predictive value of extubation failure, data were retrieved to determine the pooled sensitivity, specificity, positive likelihood ratio (LR), negative likelihood ratio (LR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC).
A total of 34 studies were recruited, with 45 study arms, and 7329 individuals undergoing 8684 tests were analysed. In all, 23 research arms administered 3018 tests to determine the cough peak flow before to extubation. Extubation failure rates were 36.2 percent and 6.3 percent, respectively, in patients with a mild and a strong cough, as determined by cough peak flow. Sensitivity, specificity, positive and negative log likelihood ratios, DOR, and AUC were 0.76 (95 percent confidence interval [CI]: 0.72–0.80), 0.75 (0.69–0.81), 2.89 (2.36–3.54), 0.37 (0.30–0.45), 8.91 (5.96–13.32), and 0.79 (0.75–0.82), respectively. Additionally, before extubation, 22 study arms administered 5666 tests to determine the semiquantitative cough strength score (SCSS). The pooled rate of extubation failure was 37.1 percent in patients with a light cough and 11.3 percent in those with a severe cough, as determined by the SCSS. Sensitivity, specificity, positive and negative LR, DOR, and AUC were 0.53 (95 percent confidence interval [CI]: 0.41–0.64), 0.83 (0.74–0.89), 2.50 (1.93–3.25), 0.65 (0.56–0.76), 4.61 (3.03–7.01), and 0.74 (0.70–0.78), respectively.
This is the first systematic study and meta-analysis to examine the predictive value of cough strength for extubation failure. Cough peak flow can be measured using an external flowmeter or a ventilator and includes voluntary and involuntary peak flow. The SCSS may be quantified using a 0–4/5 scale, the WCT, or other semiquantitative measures. Both cough peak flow and the SCSS have a modest predictive value for extubation failure. Cough peak flow, on the other hand, outperforms the SCSS in predicting extubation failure.
Weak cough is connected with a greater risk of failure during extubation. Cough peak flow and the SCSS may be used to determine it. Cough peak flow may have a greater predictive value than the SCSS for identifying extubation failure.
Reference-
Duan, J., Zhang, X. & Song, J. Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis. Crit Care 25, 357 (2021). https://doi.org/10.1186/s13054-021-03781-5
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