The following is a summary of “Assessing the reproducibility and predictive value of objective cough measurement for successful withdrawal of invasive ventilatory support in adult patients,” published in the May 2024 issue of Pulmonology by Varón-Vega et al.
This study investigates the use of clinical tests, specifically objective cough measurement, to predict the success of the weaning process in patients who were critically ill.
A multicenter observational analytical study was conducted on a prospective cohort of patients participating in the COBRE-US trial. The study evaluated the ability of objective cough measurement to predict the outcomes of spontaneous breathing trials (SBT) and extubation. Intra- and inter-observer reproducibility of the cough test was assessed using the intraclass correlation coefficient (ICC) and Cohen’s weighted kappa. Receiver operating characteristic (ROC) curves were utilized to determine the predictive capacity of the objective cough measurement.
The study included 367 patients undergoing invasive mechanical ventilation, resulting in 451 objective cough measurements and 456 SBTs. There was a significant association between objective cough measurement and successful SBT outcomes (OR: 1.68; 95% CI 1.48–1.90; p = 0.001). The ROC-curve analysis for predicting SBT success using objective cough measurement yielded an area under the curve (AUC) of 0.58 (95% CI: 0.56–0.61). For predicting successful extubation, the ROC-curve AUC was 0.61 (95% CI: 0.56–0.66). The intra-observer reproducibility of the cough measurement demonstrated a high ICC of 0.94 (95% CI: 0.89–0.96; p < 0.001), and the inter-observer reproducibility showed an ICC of 0.72 (95% CI: 0.51–0.85; p < 0.001). Intra-observer agreement, measured by Cohen’s weighted kappa, was 0.94 (95% CI: 0.93–0.99; p < 0.001), while inter-observer agreement was 0.84 (95% CI: 0.67–0.10; p < 0.001).
The objective measurement of cough using the methodology employed in this study demonstrates nearly perfect intra-observer reproducibility and high inter-observer agreement. Despite these strengths, the predictive ability of objective cough measurement for successful weaning and extubation in patients who are critically ill is limited. Further research is needed to enhance objective cough measurements’ predictive accuracy and clinical utility in the weaning process.
Source: bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-024-03033-6
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