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Highly Accessed Letter

Cough - another important factor in extubation readiness in critically ill patients

Zong-Yu Wang* and Yu Bai

Author Affiliations

Department of Intensive Care Unit, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China

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Critical Care 2012, 16:461  doi:10.1186/cc11817


See related research by Liu et al., http://ccforum.com/content/16/4/R143

Published: 13 November 2012

First paragraph (this article has no abstract)

Ling Liu and colleagues [1] found that critically ill patients who fail weaning have impaired ability to convert neuromuscular activity into tidal ventilation, highlighting the effect of diaphragm weakness on weaning and extubation from mechanical ventilation. However, it is noteworthy that the insufficient cough strength greatly contributes to failed extubation in clinical practice as well, particularly in patients with acute cervical cord injury, or who have undergone major thoracic or abdominal surgery. Some intubated patients with inadequate cough strength can successfully pass the spontaneous breathing trial, but nevertheless might still experience extubation failure afterwards. It is difficult for them to clear secretions in airways due to the inability to cough, which leads to increased risk of atelectasis and respiratory infection. Weak cough can be attributable to expiratory muscle dysfunction, inspiratory muscle weakness, and so on; however, expiratory muscle function is crucial for effective cough [2]. The major expiratory muscles include the muscles of the anterolateral wall of the abdomen, the expiratory intercostal muscle, and the triangularis sterni [3]. The neuro-ventilatory efficiency of these muscles, however, cannot be assessed by diaphragm electrical activity.