Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise

Abstract

A considerable proportion of patients who succeed in the spontaneous breathing trial (SBT) are reintubated because of the incapacity to protect their airways. This systematic review was designed to assess the cough peak flow CPF usefulness to predict the extubation outcome in patients who passed an SBT. Methods: The search covered the databases MEDLINE, EMBASE, LILACS and IBECS scientific databases, CINAHL, SciELO, Cochrane, Scopus, Web of Science, and gray literature. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the methodological quality and risk of study bias. The statistical heterogeneity of likelihood and diagnostic odds ratios was evaluated using forest plots and the Cochran’s Q statistic, and a crosshair summary receiver operator characteristic (SROC) plot using the multiple cutoffs model was calculated. Results: Many studies presented unclear risk of bias in the “patient selection”, and “flow and time” criteria. Of the 12 included studies, 7 presented “high risk” and 5 a “unclear risk” in the item “Reference Standard”, because of lack of objective clinical criteria for reintubation, use of rescue therapy and non-exclusion of patients who reintubated for laryngospasm. The diagnostic performance of CPF for extubation outcome was low to moderate when considering the results from all included studies. A subgroup analysis including only the studies with a cutoff between 55-65L/min showed a slightly better performance, however, still moderate. Conclusion: The CPF assessment considering a cutoff between 55-65L/min may be useful as a complementary measurement prior to the extubation. More well-designed studies are needed to elucidate the best method and equipment to record CPF, as well as the best cutoff.