The Predictive Value of Peak Cough Flow for Endotracheal Extubation of Patients After Craniotomy

Study Overview
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Brief Summary
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In severe cases after craniotomy, tracheal intubation is often required, and the removal of tracheal intubation presents certain risks and challenges. Premature removal of the tracheal intubation can lead to failure of extubation and increased proportion of re-intubation, resulting in increased risk of airway injury and hospital-acquired pneumonia, resulting in prolonged hospital stay and even adverse effects on neurological outcomes and mortality. . However, delayed extubation can also lead to an increased risk of hospital acquired pneumonia, affecting early recovery and neurological recovery. It can be seen that the accurate evaluation of the possibility of tracheal intubation and the appropriate timing can have a greater impact on the prognosis of patients after craniotomy. However, there are currently no relevant standards or guidelines to guide clinical work. Previous studies have shown that for general critically ill patients, Peak cough flow (PCF) can play a certain role in predicting tracheal intubation, but the results of each study are not consistent. The predictive value of PCF for tracheal intubation and extubation in patients after craniotomy is less relevant. This study intends to use Pneumotachograph to measure the active and passive PCF of patients with extubation, to explore the predictive value of PCF for tracheal intubation after craniotomy, and to provide guidance for the development of clinical extubation decisions.

Detailed Description
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The objection of this study is to evaluate the preditive value of PCF for endotracheal extubation in patients undergoing craniotomy. For patients who met the inclusion criteria, the PCF value will be measured before the removal of entracheal tubes, and the predictive value of PCF will be evaluated by ROC curves, as will as the cut-off value of PCF. Logistic regression stratified analysis will be used to adjust the influence of other risk factors of endotracheal extubation. Two subgroup analysis will be carried out. According to state of consciousness, patients will be grouped as consciousness and unconsciousness group, and the predictive value of PCF for endotracheal extubation will be evaluated seprately in both groups. For patients with disturbance of consciousness, only passive PCF value will be measured. For lucid patients, inaddition to passive PCF value, the voluntary PCF value will also be measured. According to anatomic site of lesion, patients will be divided into supratentorial and intracranial groups, and the predictive value of PCF for endotracheal extubation will be evaluated seprately in both groups.

Official Title
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The Predictive Value of Peak Cough Flow for Endotracheal Extubation of Patients After Craniotomy-A Prospective Cohort Study

Conditions
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Extubation, Craniotomy, Cough, Endotracheal Tube

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years Post- craniotomy ICU LOS ≥ 24h Exclusion Criteria: Previous chronic cardiac insufficiency (NYHA grade 4) Previous chronic respiratory insufficiency (APACHE II chronic health score) After tracheotomy History of upper airway injury, deformity or leisions Pregnant or lactating women Participation in other clinical trials Patients or immediate family members refuse to sign the informed consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Failure group<br>Patients with a failure endotracheal extubation | |
| Success group<br>Patients with a successful endotracheal extubation | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Predictive value of PCF for endotracheal extubation | Failure of extubation refers to re-intubation within 72 hours after extubation or the need for non-invasive ventilation (NIV). Predictive value of PCF for endotracheal extubation of post-craniotomy patients | 72h after extubation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mortality rates | the differences of mortality rates between patients with a failure an successful extubation | 28 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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endotracheal tube, extubation, peak cough flow, predictive value