Sonometric assessment of cough predicts extubation failure: SonoWean—a proof-of-concept study
Vincent Bonny,
Jeremie Joffre,
Paul Gabarre,
Tomas Urbina,
Louai Missri,
Mathilde Ladoire,
Maxime Gasperment,
Jean-Luc Baudel,
Bertrand Guidet,
Guillaume Dumas,
Eric Maury,
Laurent Brochard,
Hafid Ait-Oufella
Affiliations
Vincent Bonny
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Jeremie Joffre
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Paul Gabarre
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Tomas Urbina
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Louai Missri
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Mathilde Ladoire
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Maxime Gasperment
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Jean-Luc Baudel
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Bertrand Guidet
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Guillaume Dumas
Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, INSERM U1042-HP2, Université Grenoble-Alpes
Eric Maury
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Laurent Brochard
Unity Health Toronto, Keenan Research Centre, Interdepartmental Division of Critical Care Medicine, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto
Hafid Ait-Oufella
Service de Médecine Intensive Réanimation, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine
Abstract Background Extubation failure is associated with increased mortality. Cough ineffectiveness may be associated with extubation failure, but its quantification for patients undergoing weaning from invasive mechanical ventilation (IMV) remains challenging. Methods Patients under IMV for more than 24 h completing a successful spontaneous T-tube breathing trial (SBT) were included. At the end of the SBT, we performed quantitative sonometric assessment of three successive coughing efforts using a sonometer. The mean of the 3-cough volume in decibels was named Sonoscore. Results During a 1-year period, 106 patients were included. Median age was 65 [51–75] years, mainly men (60%). Main reasons for IMV were acute respiratory failure (43%), coma (25%) and shock (17%). Median duration of IMV at enrollment was 4 [3–7] days. Extubation failure occurred in 15 (14%) patients. Baseline characteristics were similar between success and failure extubation groups, except percentage of simple weaning which was lower and MV duration which was longer in extubation failure patients. Sonoscore was significantly lower in patients who failed extubation (58 [52–64] vs. 75 [70–78] dB, P < 0.001). After adjustment on MV duration and comorbidities, Sonoscore remained associated with extubation failure. Sonoscore was predictive of extubation failure with an area under the ROC curve of 0.91 (IC95% [0.83–0.99], P < 0.001). A threshold of Sonoscore < 67.1 dB predicted extubation failure with a sensitivity of 0.93 IC95% [0.70–0.99] and a specificity of 0.82 IC95% [0.73–0.90]. Conclusion Sonometric assessment of cough strength might be helpful to identify patients at risk of extubation failure in patients undergoing IMV.
