Cough Sounds Recorded via Smart Devices as Useful Non-Invasive Digital Biomarkers of Aspiration Risk: A Case Report

Spirometer measurements can reflect cough strength but might not be routinely available for patients with severe neurological or medical conditions. A digital device that can record and help track abnormal cough sound changes serially in a noninvasive but reliable manner would be beneficial for monitoring such individuals. This report includes two cases of respiratory distress whose cough changes were monitored via assessments performed using recordings made with a digital device. The cough sounds were recorded using an iPad (Apple, Cupertino, CA, USA) through an embedded microphone. Cough sounds were recorded at the bedside, with no additional special equipment. The two patients were able to complete the recordings with no complications. The maximum root mean square values obtained from the cough sounds were significantly reduced when both cases were diagnosed with aspiration pneumonia. In contrast, higher values became apparent when the patients demonstrated a less severe status. Based on an analysis of our two cases, the patients’ cough sounds recorded with a commercial digital device show promise as potential digital biomarkers that may reflect aspiration risk related to attenuated cough force. Serial monitoring aided the decision making to resume oral feeding. Future studies should further explore the clinical utility of this technique.

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

Background The predictive power of extubation failure diagnosed by cough strength varies by study. Here we summarise the diagnostic power of extubation failure tested by cough strength. Methods A comprehensive online search was performed to select potentially eligible studies that evaluated the predictive power of extubation failure tested by cough strength. A manual search was also performed to identify additional studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the predictive power of extubation failure. Results A total of 34 studies involving 45 study arms were enrolled, and 7329 patients involving 8684 tests were analysed. In all, 23 study arms involving 3018 tests measured cough peak flow before extubation. The pooled extubation failure was 36.2% and 6.3% in patients with weak and strong cough assessed by cough peak flow, respectively. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.76 (95% confidence interval [CI]: 0.72–0.80), 0.75 (0.69–0.81), 2.89 (2.36–3.54), 0.37 (0.30–0.45), 8.91 (5.96–13.32), and 0.79 (0.75–0.82), respectively. Moreover, 22 study arms involving 5666 tests measured the semiquantitative cough strength score (SCSS) before extubation. The pooled extubation failure was 37.1% and 11.3%, respectively, in patients with weak and strong cough assessed by the SCSS. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.53 (95% CI: 0.41–0.64), 0.83 (0.74–0.89), 2.50 (1.93–3.25), 0.65 (0.56–0.76), 4.61 (3.03–7.01), and 0.74 (0.70–0.78), respectively. Conclusions Weak cough is associated with increased extubation failure. Cough peak flow is superior to the SCSS for predicting extubation failure. However, both show moderate power for predicting extubation failure.

Predictive Power of Extubation Failure Diagnosed by Cough Strength: A Systematic Review and Meta-Analysis

Background: The predictive power of extubation failure diagnosed by cough strength is various in different studies. We aimed to summarize the diagnostic power of extubation failure tested by cough strength. Methods: A comprehensive on-line search was performed to select any potentially eligible studies that evaluated the predictive power of extubation failure tested by cough strength. A manual research was also performed to identify additional studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curves (AUC) to evaluate predictive power of extubation failure. I2 was used to test the heterogeneity and deek’s funnel plot was used to detect the publication bias.Results: A total of 35 studies involving 7515 patients were included. Of them, 1113 patients (14.8%) experienced extubation failure. Twenty studies involving 2787 patients assessed cough strength by measure of cough peak flow (CPF) to predict extubation failure. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.77 (95%CI: 0.72-0.80), 0.75 (0.69-0.80), 2.84 (2.36-3.42), 0.34 (0.29-0.39), 9.16 (6.14-13.67), and 0.81 (0.77-0.84), respectively. Twenty studies involving 5508 patients assessed cough strength by measurement of a semiquantitative cough strength scale (SCSS) to predict extubation failure. The pooled sensitivity, specificity, positive LR, negative LR, DOR, and AUC were 0.54 (95%CI: 0.43-0.65), 0.82 (0.73-0.88), 2.48 (1.92-3.21), 0.63 (0.54-0.74), 4.61 (3.03-7.01), and 0.74 (0.70-0.78), respectively. Conclusions: Cough strength can be measured by CPF and SCSS. The CPF has good predictive power to diagnose extubation failure and SCSS has moderate predictive power.

Airway Care Interventions for Invasively Ventilated Critically Ill Adults—A Dutch National Survey

Airway care interventions may prevent accumulation of airway secretions and promote their evacuation, but evidence is scarce. Interventions include heated humidification, nebulization of mucolytics and/or bronchodilators, manual hyperinflation and use of mechanical insufflation-exsufflation (MI-E). Our aim is to identify current airway care practices for invasively ventilated patients in intensive care units (ICU) in the Netherlands. A self–administered web-based survey was sent to a single pre–appointed representative of all ICUs in the Netherlands. Response rate was 85% (72 ICUs). We found substantial heterogeneity in the intensity and combinations of airway care interventions used. Most (81%) ICUs reported using heated humidification as a routine prophylactic intervention. All (100%) responding ICUs used nebulized mucolytics and/or bronchodilators; however, only 43% ICUs reported nebulization as a routine prophylactic intervention. Most (81%) ICUs used manual hyperinflation, although only initiated with a clinical indication like difficult oxygenation. Few (22%) ICUs used MI-E for invasively ventilated patients. Use was always based on the indication of insufficient cough strength or as a continuation of home use. In the Netherlands, use of routine prophylactic airway care interventions is common despite evidence of no benefit. There is an urgent need for evidence of the benefit of these interventions to inform evidence-based guidelines.

A Survey of Mechanical Ventilation Weaning Practices in ICUs of Bangladesh

Objective : To determine mechanical ventilation discontinuation (weaning) practices in Bangladesh as there is currently no data available on this issue. Method : Analyzing the Survey on Bangladeshi respondents using questionnaire developed by and used by a pan Asian study where Bangladesh critical care physicians participated. Result : 40 physicians from 10 ICUs of Bangladesh participated. Majority of our participating doctors (62.5%) came from private for profit hospital. 19 out of 40 respondents were certified in critical care medicine. In our study spontaneous breathing trial (SBT) was liberally used with pressure support being used by 30% respondents. Most of the extubation trial took place during day. As criteria for extubation, respondents mainly considered consciousness and cooperation and along with gag reflex, cough strength, suction frequency and cuff leak at different times. Noninvasive ventilation (NIV) was commonly used for early extubation in cases of COPD, cardiogenic pulmonary edema, neuromuscular disorders, post-operative cases and obesity. Slightly less than half of respondents did not follow any sedation protocol and 42.5% followed weaning protocol. Protocolized weaning by nurses are not known to be practiced in Bangladesh. Conclusion : Weaning practices are diverse in Bangladeshi ICUs. Protoclized weaning is rarely practiced in Bangladesh. Bangladesh Crit Care J March 2021; 9(1): 4-11