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

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). 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. 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). 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.