EFFECTIVENESS OF COUGH ASSIST IN THE EXTUBATION OF ADULT PATIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

In Intensive Care Unit (ICU), failure of extubation, resulting in the need for reintubation, mayoccur in 2-25% of Patients undergoing extubation[1].

The purpose of this review and meta-analysiswas to determine the effectiveness of cough assist in improving success rates of extubation compared with standard treatment.

Inclusion criteria were; Randomized Control Trials, which compared cough assist and conventional therapy in adult population in intensive care unit whith conventional therapy only. Outcomes representing the efficacy of the cough assist were: quantity and quality of secretions (weight, volume, and density), number of reintubation, indices of thoraco-pulmonary function.

The search string produced 764 studies, and only 5 studies eligible for review. Overall, a total of 331 participants were enrolled in the five studies selected.

Of the meta-analyzed outcomes, the calculation of the effect size for the weight of secretions is the one that gave the best results, while no statistical difference was found in the other outcomes. In none of the meta-analysis studies were observed adverse effects in the use of in-exsufflator.

Our systematically review edsuggest sthatcough assist might be feasible and effective in patients intubated in ICU, but studies with larger sample sizes and well-defined outcomes are still required to obtain conclusive evidence.