Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis
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...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-021-03781-5 |
| _version_ | 1818897142238937088 |
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| author | Jun Duan Xiaofang Zhang Jianping Song |
| author_facet | Jun Duan Xiaofang Zhang Jianping Song |
| author_sort | Jun Duan |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-19T19:11:28Z |
| format | Article |
| id | doaj.art-a8a9dfd26fdd4a1ca92039ce8fe027f2 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-19T19:11:28Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-a8a9dfd26fdd4a1ca92039ce8fe027f22022-12-21T20:09:17ZengBMCCritical Care1364-85352021-10-0125111210.1186/s13054-021-03781-5Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysisJun Duan0Xiaofang Zhang1Jianping Song2Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical UniversityDepartment of Geriatric Respiratory, People’s Hospital of Wenjiang DistrictDepartment of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical and Pharmaceutical CollegeAbstract 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.https://doi.org/10.1186/s13054-021-03781-5Ventilator weaningWeak coughSensitivitySpecificity |
| spellingShingle | Jun Duan Xiaofang Zhang Jianping Song Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis Critical Care Ventilator weaning Weak cough Sensitivity Specificity |
| title | Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis |
| title_full | Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis |
| title_fullStr | Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis |
| title_full_unstemmed | Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis |
| title_short | Predictive power of extubation failure diagnosed by cough strength: a systematic review and meta-analysis |
| title_sort | predictive power of extubation failure diagnosed by cough strength a systematic review and meta analysis |
| topic | Ventilator weaning Weak cough Sensitivity Specificity |
| url | https://doi.org/10.1186/s13054-021-03781-5 |
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