From the Research
Peak Expiratory Flow Threshold for Endotracheal Intubation
- The peak expiratory flow (PEF) threshold for endotracheal intubation is a crucial factor in determining the success of extubation 1, 2, 3, 4, 5.
- Studies have shown that a PEF of less than 60 L/min is associated with an increased risk of failed extubation 1, 2.
- A study published in 2009 found that a cough peak expiratory flow (CPEF) of less than or equal to 58.5 L/min was a predictor of extubation failure, with a specificity of 68.0% and sensitivity of 71.4% 2.
- Another study published in 2014 found that voluntary cough peak flow (V-CPF) was a better predictor of re-intubation than involuntary cough peak flow (IV-CPF), with a cutoff value of 43.2 L/min 3.
- A systematic review and meta-analysis published in 2021 found that a cough peak flow assessment considering a cutoff between 55 and 65 L/minute may be useful as a complementary measurement prior to extubation, with a diagnostic odds ratio of 6.450 (95%CI 4.490 - 9.090) 4.
- A recent study published in 2023 found that cough peak expiratory flow (CPF) can be assessed without disconnecting the patient from the ICU ventilator, with a correlation coefficient of 0.63 (95% CI 0.45-0.76) between CPF obtained with the built-in ventilator flow meter and CPF obtained with an electronic portable handheld peak flow meter 5.
Key Findings
- PEF threshold for endotracheal intubation: less than 60 L/min 1, 2
- CPEF predictor of extubation failure: less than or equal to 58.5 L/min 2
- V-CPF predictor of re-intubation: cutoff value of 43.2 L/min 3
- Cough peak flow assessment: cutoff between 55 and 65 L/minute may be useful prior to extubation 4
- CPF assessment without disconnection from ICU ventilator: correlation coefficient of 0.63 (95% CI 0.45-0.76) 5