Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise
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| Auteur principal: | |
|---|---|
| Date de publication: | 2020 |
| Format: | Doctoral thesis |
| Langue: | por |
| Source: | Repositório Comum do Brasil - Deposita |
| Download full: | https://deposita.ibict.br/handle/deposita/123 |
Résumé: | 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. |
| _version_ | 1872168157868720128 |
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| author | Ferreira, Natália |
| author_browse | Ferreira, Natália |
| author_facet | Ferreira, Natália |
| author_role | author |
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| collection | Repositório Comum do Brasil - Deposita |
| contributor_str_mv | Guimarães, Fernando Ferreira, Arthur |
| dc.contributor.advisor-co1.fl_str_mv | Ferreira, Arthur |
| dc.contributor.advisor1.fl_str_mv | Guimarães, Fernando |
| dc.contributor.author.fl_str_mv | Ferreira, Natália |
| dc.contributor.authorLattes.fl_str_mv | http://lattes.cnpq.br/7641819325213725 |
| dc.date.accessioned.fl_str_mv | 2020-07-16T18:22:32Z |
| dc.date.issued.fl_str_mv | 2020 |
| dc.format.none.fl_str_mv | application/pdf application/pdf |
| dc.identifier.uri.fl_str_mv | https://deposita.ibict.br/handle/deposita/123 |
| dc.language.iso.fl_str_mv | por |
| dc.publisher.country.fl_str_mv | Brasil |
| dc.publisher.department.fl_str_mv | Centro Universitário Augusto Motta |
| dc.publisher.none.fl_str_mv | Centro Universitário Augusto Motta |
| dc.publisher.program.fl_str_mv | Programa de Pós-graduação em Ciências da Reabilitação |
| dc.rights.driver.fl_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
| dc.source.none.fl_str_mv | reponame:Repositório Comum do Brasil - Deposita instname:Instituto Brasileiro de Informação em Ciência e Tecnologia (Ibict) instacron:IBICT |
| dc.subject.cnpq.fl_str_mv | Fisioterapia e Terapia Ocupacional |
| dc.subject.por.fl_str_mv | Desmame Extubação Ventilação mecânica Tosse |
| dc.title.por.fl_str_mv | Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise |
| dc.type.driver.fl_str_mv | info:eu-repo/semantics/doctoralThesis |
| dc.type.status.fl_str_mv | info:eu-repo/semantics/publishedVersion |
| description | 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. |
| eu_rights_str_mv | openAccess |
| format | doctoralThesis |
| id | IBICT-1_2049126f4fd71b2f516a525d4229deea |
| instacron_str | IBICT |
| institution | IBICT |
| instname_str | Instituto Brasileiro de Informação em Ciência e Tecnologia (Ibict) |
| language | por |
| network_acronym_str | IBICT-1 |
| network_name_str | Repositório Comum do Brasil - Deposita |
| oai_identifier_str | oai:deposita.ibict.br:deposita/123 |
| publishDate | 2020 |
| publishDateSort | 2020 |
| publisher.none.fl_str_mv | Centro Universitário Augusto Motta |
| reponame_str | Repositório Comum do Brasil - Deposita |
| repository.mail.fl_str_mv | deposita@ibict.br |
| repository.name.fl_str_mv | Repositório Comum do Brasil - Deposita - Instituto Brasileiro de Informação em Ciência e Tecnologia (Ibict) |
| repository_id_str | 4658 |
| rights_invalid_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| spelling | Guimarães, FernandoFerreira, Arthurhttp://lattes.cnpq.br/7641819325213725Ferreira, Natália2020-07-16T18:22:32Z2020https://deposita.ibict.br/handle/deposita/123A 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.Uma porcentagem significativa de pacientes que obtêm sucesso no teste de respiração espontânea (TRE) é reintubada devido à incapacidade de proteger as vias aéreas. Esta revisão sistemática foi realizada para analisar a capacidade do pico de fluxo da tosse (PFT) em predizer o desfecho da extubação em pacientes que passaram no TRE. Métodos: A pesquisa abrangeu as bases de dados científicos MEDLINE, EMBASE, LILACS e IBECS, Scopus, Cochrane, Web of Science, CINAHL, SciELO e literatura cinzenta. O instrumento de avaliação Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) foi utilizado para avaliar a qualidade metodológica e o risco de viés do estudo. A heterogeneidade estatística através do likelihood e odds ratio foi avaliada usando gráfico de forest plot e através da estatística Q de Cochran, e calculou-se a curva SROC (summary receiver operating characteristic) utilizando múltiplos pontos de corte. Resultados: Muitos estudos apresentaram “risco incerto” de viés nos critérios de “seleção de pacientes” e “fluxo e tempo”. Dos 12 estudos incluídos, 7 apresentaram “alto risco” e 5 “risco incerto” no item “padrão de referência”, devido à falta de critérios clínicos objetivos para reintubação, uso de terapia de resgate e não exclusão de pacientes que reintubaram por laringoespasmo. A predição diagnóstica da PFT para o resultado da extubação foi baixa a moderada, considerando os resultados de todos os estudos incluídos. Uma análise de subgrupo incluindo apenas os estudos com ponto de corte entre 55-65 L/min mostrou um desempenho um pouco melhor, porém ainda moderado. Conclusão: A avaliação do PFT considerando um ponto de corte entre 55-65 L/min pode ser útil como uma medida complementar antes da extubação. São necessários mais estudos com protocolos bem estabelecidos para elucidar o melhor método e equipamento para registrar o PFT, bem como o melhor ponto de corte.Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorSudeste-1application/pdfapplication/pdfporCentro Universitário Augusto MottaPrograma de Pós-graduação em Ciências da ReabilitaçãoBrasilCentro Universitário Augusto Mottahttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessDesmameExtubaçãoVentilação mecânicaTosseFisioterapia e Terapia OcupacionalPico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanáliseinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisreponame:Repositório Comum do Brasil - Depositainstname:Instituto Brasileiro de Informação em Ciência e Tecnologia (Ibict)instacron:IBICTTEXT2020 Tese Natália de Araújo Ferreira.pdf.txtWritten by FormatFilter org.dspace.app.mediafilter.TikaTextExtractionFilter on 2025-06-06T20:13:45Z (GMT).Extracted texttext/plain102097https://deposita.ibict.br/bitstreams/4f4487fc-2d88-4722-98f9-66b667e60260/download4620e9b2eb751fbdce781fb9fe1751c0MD56falseAnonymousREADTHUMBNAIL2020 Tese Natália de Araújo Ferreira.pdf.jpgWritten by FormatFilter org.dspace.app.mediafilter.PDFBoxThumbnail on 2025-06-06T20:13:45Z (GMT).Generated Thumbnailimage/jpeg3182https://deposita.ibict.br/bitstreams/839c6022-2764-449d-baf4-9945370914f4/download100fa50a8727f5dcc049b67f26f3a0c1MD57falseAnonymousREADLICENSElicense.txtWritten by org.dspace.content.LicenseUtilstext/plain; 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| spellingShingle | Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise Ferreira, Natália Desmame Extubação Ventilação mecânica Tosse Fisioterapia e Terapia Ocupacional |
| status_str | publishedVersion |
| title | Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise |
| title_full | Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise |
| title_fullStr | Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise |
| title_full_unstemmed | Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise |
| title_short | Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise |
| title_sort | Pico de fluxo da tosse como preditor de sucesso na extubação orotraqueal: revisão sistemática com metanálise |
| topic | Desmame Extubação Ventilação mecânica Tosse Fisioterapia e Terapia Ocupacional |
| url | https://deposita.ibict.br/handle/deposita/123 |