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

Duan, Jun; Zhang, Xiaofang; Song, Jianping

doi:10.1186/s13054-021-03781-5

Critical Care

Table 1 Characteristics of the included studies

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

Author	Year	Country	Design	Method of SBT	Measurement of cough strength	Definition of weak cough	Total tests	TP	FP	FN	TN	Time and definition of extubation failure
Beuret	2009	France	Prospective	T-piece	Voluntary CPF tested with an external flowmeter	CPF ≤ 35 L/min	130	11	34	3	82	48 h	Reintubation
Duan	2014a	China	Prospective	PSV	Voluntary CPF tested with an external flowmeter	CPF ≤ 62.4 L/min	115	17	34	3	61	72 h	Reintubation
Duan	2014b	China	Prospective	PSV	#Involuntary CPF tested with an external flowmeter	CPF ≤ 49.8 L/min	115	14	32	6	63	72 h	Reintubation
Gao	2009a	China	Prospective	PSV/CPAP	Voluntary CPF tested with a ventilator	CPF ≤ 58.5 L/min	200	20	55	8	117	72 h	Reintubation/death
Gao	2009b	China	Prospective	PSV/CPAP	SCSS (strong, moderate, weak)	Weak	200	13	3	15	169	72 h	Reintubation/death
Salam	2004a	USA	Prospective	T-piece/PSV	Voluntary CPF tested with an external flowmeter	CPF ≤ 60 L/min	88	11	25	3	49	72 h	Reintubation
Salam	2004b	USA	Prospective	T-piece/PSV	WCT	Negative	88	10	36	4	38	72 h	Reintubation
Smailes	2013	UK	Prospective	T-piece	Voluntary CPF tested with an external flowmeter	CPF ≤ 60 L/min	125	10	7	7	101	48 h	Reintubation
Smina	2003	USA	Prospective	T-piece/PSV	Voluntary CPF tested with an external flowmeter	CPF ≤ 60 L/min	111	9	25	4	73	72 h	Reintubation
Su	2010a	China	Prospective	T-piece/PSV/CPAP	#Involuntary CPF tested with an external flowmeter	CPF ≤ 58.5 L/min	150	25	25	7	93	Hospital stay	Reintubation
Su	2010b	China	Prospective	T-piece/PSV/CPAP	SCSS (strong, weak, no cough)	Weak or no cough	150	25	47	7	71	Hospital stay	Reintubation
Khamiees	2001a	China	Prospective	T-piece/PSV/CPAP	SCSS (grade 0 to 5)	Grade 0 to 2	100	10	14	8	68	72 h	Reintubation
Khamiees	2001b	China	Prospective	T-piece/PSV/CPAP	WCT	Negative	100	9	16	9	66	72 h	Reintubation
Huang	2013	China	Retrospective	T-piece/PSV	SCSS (effective and ineffective)	Ineffective	119	23	27	4	65	7 d	Reintubation
Gobert	2017	France	Prospective	PSV	Voluntary CPF tested with a ventilator	CPF ≤ 60 L/min	92	7	24	4	57	48 h	Reintubation/death
Liu	2014	China	Prospective	PSV	Voluntary CPF tested with a ventilator	CPF ≤ 60 L/min	102	8	36	7	51	48 h	Reintubation
Duan	2015a	China	Prospective	PSV	SCSS (grade 0 to 5)	Grade 0 to 2	186	16	52	12	106	72 h	Reintubation
Duan	2015b	China	Prospective	PSV	Voluntary CPF tested with an external flowmeter	CPF ≤ 60 L/min	186	23	71	5	87	72 h	Reintubation
Bai	2017a	China	Prospective	PSV	Voluntary CPF tested with an external flowmeter	CPF ≤ 56.4 L/min	126	11	14	4	97	72 h	Reintubation
Bai	2017b	China	Prospective	PSV	Voluntary CPF tested with an external ventilator	CPF ≤ 56 L/min	126	11	16	4	95	72 h	Reintubation
Xiao	2018	China	Prospective	PSV	Voluntary CPF tested with an external flowmeter	CPF ≤ 60 L/min	139	15	36	7	81	72 h	Reintubation
Duan	2017	China	Prospective	PSV	Voluntary CPF tested with an external flowmeter	CPF ≤ 70 L/min	356	61	119	15	161	7 d	Reintubation
Thille	2015	France	Prospective	PSV	SCSS (grade 0 to 4)	Grade 0 to 2	223	10	15	20	178	7 d	Reintubation
Kutchak	2015	Brazil	Prospective	T-piece	$Involuntary CPF tested with an external flowmeter	CPF ≤ 80 L/min	135	35	20	10	70	48 h	Reintubation
Almeida	2020a	Brazil	Prospective	T-piece/PSV	Voluntary CPF tested with an external flowmeter	CPF ≤ 45 L/min	81	23	3	10	45	48 h	Reintubation
Almeida	2020b	Brazil	Prospective	T-piece/PSV	#Involuntary CPF tested with an external flowmeter	CPF ≤ 60 L/min	81	29	4	4	44	48 h	Reintubation
Almeida	2020c	Brazil	Prospective	T-piece/PSV	$Involuntary CPF tested with an external flowmeter	CPF ≤ 55 L/min	81	30	7	3	41	48 h	Reintubation
Aziz	2018	Egypt	Prospective	Not reported	SCSS (grade 0 to 5)	Grade 0 to 2	80	18	3	19	40	72 h	Reintubation
Vivier	2019a	France	Prospective	T-piece	SCSS (ineffective, moderate, and effective)	Ineffective	181	6	7	27	141	7 d	Reintubation/death
Vivier	2019b	France	Prospective	T-piece	Voluntary CPF tested by an external flowmeter	CPF ≤ 60L/min	160	18	74	10	58	7 d	Reintubation/death
Wang	2019	China	Retrospective	Not reported	SCSS (with or without spontaneous cough)	Without spontaneous cough	86	19	0	6	61	Hospital stay	Reintubation
Ma	2018	China	Retrospective	Not reported	SCSS (strong, weak, no cough)	Weak or no cough	108	11	6	8	83	48 h	Reintubation
Frutos-Vivar	2006	Canada	Prospective	T-piece/PSV/CPAP	SCSS (poor, moderate, or excellent)	Poor	900	33	178	88	601	72 h	Reintubation
Jaber	2018	France	Prospective	T-piece/PSV/CPAP	SCSS (weak and strong)	Weak	1505	116	811	32	546	48 h	Reintubation
Dos	2017	Brazil	Prospective	T-piece/PSV	SCSS (grade 0 to 5)	Grade 0 to 2	311	8	21	35	247	48 h	Reintubation
Michetti	2018	USA	Prospective	PSV/CPAP	SCSS (not strong and strong)	Not strong	464	11	142	24	287	96 h	Reintubation
Abbas	2018	Egypt	Prospective	Not reported	SCSS (grade 0 to 5)	Grade 0 to 2	90	7	11	19	53	48 h	Reintubation/NIV
Norisue	2020	Japan	Prospective	PSV	Voluntary CPF tested with a ventilator	CPF ≤ 50 L/min	252	8	62	4	178	72 h	Reintubation
Sanson	2018	Italy	Prospective	Not reported	SCSS (strong, weak, no cough)	Weak or no cough	205	21	121	5	58	ICU stay	Reintubation/NIV
Wang	2009a	China	Prospective	PSV	SCSS (grade 0 to 5)	Grade 0 to 2	68	9	9	11	39	72 h	Reintubation
Wang	2009b	China	Prospective	PSV	WCT	Negative	68	10	11	10	37	72 h	Reintubation
Elkholy	2021	Egypt	Prospective	PSV	WCT	Negative	150	21	24	1	104	72 h	Reintubation
Lu	2010	China	Prospective	PSV	Voluntary CPF tested with an external flowmeter	CPF ≤ 29.35 L/min	19	7	4	0	8	72 h	Reintubation
Liang	2019	China	Prospective	PSV	#Involuntary CPF tested with a ventilator	CPF ≤ 71.15 L/min	48	8	4	2	34	48 h	Reintubation/death
Thille	2020	France	Prospective	T-piece/PSV	SCSS (grade 0 to 4)	Grade 0 to 1	284	11	16	45	212	7 d	Reintubation/death

Letters a, b, and c after the year (e.g. 2014a and 2014b) represent different arms of a given study
^#Cough was stimulated with 2 mL normal saline
^$Cough was stimulated with suction catheter
CPF = cough peak flow, SCSS = semiquantitative cough strength score, WCT = white card test, TP = true positive, FP = false positive, FN = false negative, TN = true negative, NIV = noninvasive ventilation, SBT = spontaneous breathing trial, PSV = pressure support ventilation, CPAP = continuous positive airway pressure
Sensitivity = true positives/(true positives + false negatives). Specificity = true negatives/(true negatives + false positives)
True positives were patients with ineffective cough who failed extubation. False negatives were patients with effective cough who failed extubation
True negatives were patients with effective cough who were successfully extubated. False positives were patients with ineffective cough who were successfully extubated

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ISSN: 1364-8535

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