Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis

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Abstract

Background

The predictive power of extubation failure diagnosed by cough strength varies by study. Here we summarise the diagnostic power of extubation failure tested by cough strength.

Methods

A comprehensive online search was performed to select potentially eligible studies that evaluated the predictive power of extubation failure tested by cough strength. A manual search was also performed to identify additional studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the predictive power of extubation failure.

Results

A total of 34 studies involving 45 study arms were enrolled, and 7329 patients involving 8684 tests were analysed. In all, 23 study arms involving 3018 tests measured cough peak flow before extubation. The pooled extubation failure was 36.2% and 6.3% in patients with weak and strong cough assessed by cough peak flow, respectively. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.76 (95% 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. Moreover, 22 study arms involving 5666 tests measured the semiquantitative cough strength score (SCSS) before extubation. The pooled extubation failure was 37.1% and 11.3%, respectively, in patients with weak and strong cough assessed by the SCSS. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.53 (95% 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.

Conclusions

Weak cough is associated with increased extubation failure. Cough peak flow is superior to the SCSS for predicting extubation failure. However, both show moderate power for predicting extubation failure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-021-03781-5.

Related collections

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Author and article information

Contributors

Jun Duan:

ORCID: http://orcid.org/0000-0003-1685-0117

duanjun412589@163.com

Jianping Song: 125718258@qq.com

Journal

Journal ID (nlm-ta): Crit Care

Title: Critical Care

Publisher: BioMed Central (London )

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Electronic): 12 October 2021

Publication date PMC-release: 12 October 2021

Publication date Collection: 2021

Volume: 25

Electronic Location Identifier: 357

Affiliations

[1 ]GRID grid.452206.7, Department of Respiratory and Critical Care Medicine, , The First Affiliated Hospital of Chongqing Medical University, ; Youyi Road 1, Yuzhong District, Chongqing, 400016 China

[2 ]Department of Geriatric Respiratory, People’s Hospital of Wenjiang District, Kangtai Road 86, Wenjiang District, Chengdu, Sichuan Province 611130 China

[3 ]GRID grid.459453.a, ISNI 0000 0004 1790 0232, Department of Rehabilitation Medicine, , The First Affiliated Hospital of Chongqing Medical and Pharmaceutical College, ; Nancheng Road 301, Nan’an District, Chongqing, 400060 China

Author information

Jun Duan http://orcid.org/0000-0003-1685-0117

Article

Publisher ID: 3781

DOI: 10.1186/s13054-021-03781-5

PMC ID: 8513306

PubMed ID: 34641973

SO-VID: 12f189e7-4688-4c51-98f7-4e63a8b586b3

License:

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