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

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

doi:10.1186/s13613-018-0410-x

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

Ann Intensive Care. 2018 May 8;8(1):61. doi: 10.1186/s13613-018-0410-x.

Authors

Yasuhiro Norisue^{1

2

3}, Jun Kataoka⁴, Yosuke Homma⁴, Takaki Naito⁵, Junpei Tsukuda⁵, Kentaro Okamoto⁵, Takeshi Kawaguchi⁵, Lonny Ashworth⁶, Shimada Yumiko⁴, Yuiko Hoshina⁴, Eiji Hiraoka⁴, Shigeki Fujitani⁵

Affiliations

¹ Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 2790001, Japan. norisue.yasuhiro@gmail.com.
² Department of Emergency and Critical Care Medicine, St. Marianna University Hospital, 2-16-1 Sugao, Kawasaki, Kanagawa, 2168511, Japan. norisue.yasuhiro@gmail.com.
³ Department of Pulmonary and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 2790001, Japan. norisue.yasuhiro@gmail.com.
⁴ Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 2790001, Japan.
⁵ Department of Emergency and Critical Care Medicine, St. Marianna University Hospital, 2-16-1 Sugao, Kawasaki, Kanagawa, 2168511, Japan.
⁶ Department of Respiratory Care, Boise State University, 1910 W University Drive, Boise, ID, 83725, USA.

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.

Keywords: Airway suctioning; Cough; Extubation; Intra-abdominal pressure; Mechanical ventilation.