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

Annals of Intensive Care

Kentaro Okamoto¹  Takaki Naito¹  Junpei Tsukuda¹  Takeshi Kawaguchi¹  Shigeki Fujitani¹  Yasuhiro Norisue²  Yosuke Homma²  Jun Kataoka²  Eiji Hiraoka²  Shimada Yumiko²  Yuiko Hoshina²  Lonny Ashworth³ 

[1] Department of Emergency and Critical Care Medicine, St. Marianna University Hospital;Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center;Department of Respiratory Care, Boise State University;

关键词: Cough;    Airway suctioning;    Extubation;    Intra-abdominal pressure;    Mechanical ventilation;   

DOI  :  10.1186/s13613-018-0410-x

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown