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.
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Ashworth, Lonny. (2018). "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, 8(1), 61-1 - 61-6.