Peut-on prédire l'encombrement bronchique post-extubation ?

Sputum retention is one of the main causes of extubation failure. The occurrence before extubation of an inefficient cough, copious bronchial secretions or an abnormal mental status are some factors frequently pointed out as responsible for the occurrence of post-extubation sputum retention. However, their own predictive value is low. Conversely, an objective evaluation of cough strength by the measure of the peak cough expiratory flow (PCEF) may help for the decision of extubation. This measure is easy to achieve before extubation, the use of an electronic flowmeter is advised. An efficient cough certified by the value of PCEF predicts accurately the success of extubation. The inability to cough at order or a PCEF lower than the threshold value identifies patients “at risk” of failure needing a strict supervision after extubation. The association for a patient of a poor cough strength, copious bronchial secretions and an abnormal mental status results in a high risk of extubation failure, cautioning against extubation.