scholarly journals Diaphragmatic rapid shallow breathing index for predicting weaning outcome from mechanical ventilation: Comparison with traditional rapid shallow breathing index

2019 ◽  
Vol 35 (1) ◽  
pp. 9-17
Author(s):  
Sherif M.S. Mowafy ◽  
Essam F. Abdelgalel
Keyword(s):  
Mechanical Ventilation ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Weaning Outcome ◽  
Rapid Shallow Breathing

scholarly journals Ventilator induced Diaphragmatic Dysfunction assessed by Ultrasonography and its impact on Weaning outcome

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H M A Fawzy ◽  
M H M Hassan ◽  
A A M Alkholy
Keyword(s):  
Mechanical Ventilation ◽  
Operating Characteristics ◽  
Diaphragmatic Dysfunction ◽  
Rapid Shallow Breathing Index ◽  
Weaning Failure ◽  
Significant Difference ◽  
Shallow Breathing ◽  
Ventilation Modes ◽  
Weaning Outcome ◽  
Rapid Shallow Breathing

Abstract Background Ventilator induced diaphragmatic dysfunction (VIDD), as a loss of diaphragmatic force generating capacity due to the use of mechanical ventilation. Difficulties in discontinuing ventilatory support are encountered in 20–25% of mechanically ventilated patients, with a staggering 40% of time spent in the intensive care unit being devoted to weaning. M-mode ultrasonography is now an accepted qualitative method of assessing diaphragmatic motion in normal and pathological conditions. In this study, we evaluated whether diaphragmatic excursion (DE) as measured by M-mode sonography can be a predictor of weaning and diagnosis of VIDD. Aim The aim of this study is to determine the presence of ventilator induced diaphragmatic dysfunction (VIDD) diagnosed by M-mode ultrasonography and its impact on weaning outcome. Methodology This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 78 patients between August 2017 to August 2018. who required mechanical ventilation ≥72hrs. who fulfilled the spontaneous breath trial (SBT) criteria, at the start of a 1-hr SBT, each hemidiaphragm was evaluated M-mode sonography with the patient in the supine position. Rapid shallow Breathing index (RSBI) was simultaneously calculated at the bedside. Ultrasonographic Diaphragmatic Dysfunction (DD) was diagnosed if an Diaphragmatic Excursion (DE) was <10 mm or negative, the latter indicating paradoxical diaphragmatic movement. Results Diaphragmatic Dysfunction (DD) among the eligible 78 patients was 48% (n = 37). DD group had longer weaning time [39,2 (26-56) hrs. vs. 22.3 (30-16) hrs. p = 0.001) in DD vs. NDD group respectively and total ventilation time [140 (130-150) hrs. vs. 130 (120–140) hrs. p > 0.05) in DD vs. NDD group respectively. Weaning failure was (45.8% vs. 30.8%, p=0.01) in DD vs. NDD group respectively. In NDD group Rt. DE, mean 25.4 ±4.1 mm. While Lt. side was 25.3±4.6 mm, 11.25mm and 22mm (45-15) respectively. In DD group Rt. DE, mean 7.6 ±2.02mm, IQR 2.4 mm and median 8.2mm (10-1.9). While Lt. side was 9.2±0.8mm, 4.3mm and 8.9mm (9.8-5.7) respectively. The area under the receiver operating characteristics curve (ROC) of ultrasonographic criteria in predicting weaning failure was near similar to that of rapid shallow breathing index. Hypercapenic acidosis in NDD group might protect them from VIDD Conclusions DD is present in a significant percentage 48% (nearly half) of our medical ICU patients on MV ≥ 72 hrs which largely account for weaning failure. DD was associated with a significant longer weaning time, and ICU stay, with no significant difference in 30 day mortality Recommendations DE by US measurements is a valuable tool and is recommended as an adjunctive weaning index to aid prediction of weaning outcome. Evaluating the role of spontaneous ventilation modes and advanced ventilation modes as PAV and NAVA effects on decreas ing VIDD versus controlled modes.

The Role of Diaphragmatic Rapid Shallow Breathing Index and Maximum Inspiratory Pressure in Predicting Outcome of Weaning From Mechanical Ventilation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Galal Adel Mohamed Abd Al Rahem Al Kadi ◽  
Raham Hasan Mostafa ◽  
Omnia Mohamed Mostafa Helwa ◽  
Ahmed Fathy Ahmed Abd-Allah
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Weaning From Mechanical Ventilation ◽  
Mechanically Ventilated ◽  
Maximum Inspiratory Pressure ◽  
Rapid Shallow Breathing Index ◽  
Inspiratory Muscles ◽  
Shallow Breathing ◽  
Weaning Outcome ◽  
Rapid Shallow Breathing

Abstract Background Mechanical ventilation is the defining event of intensive care unit (ICU) management. It is a lifesaving intervention in patients with acute respiratory failure and whose spontaneous ventilation is inadequate for subsequent development of life threatening hypoxia and/or respiratory acidosis. Many physicians simply look at the patient’s ability to tolerate a spontaneous breathing trial (SBT) without distress through the respiratory rate (RR) and TV during the SBT. The RR/TV ratio, i.e., the rapid shallow breathing index (RSBI), one of the most used clinical indices to predict weaning outcome, reflects the balance between mechanical load posed on the inspiratory muscles and the inspiratory muscles ability to face it during the weaning attempt. However, RSBI was found to have both variable sensitivity and specificity for predicting weaning outcome. Although the diaphragm plays a fundamental role in generating TV in healthy subjects, if the diaphragmatic efficiency is impaired the accessory inspiratory muscles mild contribute to the ventilation for a limited period of time, for example during a SBT. However, since they are by far less efficient and more fatigable than the diaphragm, their exhaustion was likely lead to weaning failure in subsequent hours. Hence, the contribution of the accessory muscles to TV could compromise the diagnostic accuracy of the RSBI by masking the underlying diaphragmatic dysfunction. Aim of the Work To assess the accuracy of Diaphragmatic Rapid shallow breathing index and Maximum inspiratory pressure in predicting the outcome of weaning from mechanical ventilation. Patients and Methods The study was conducted at Ain Shams University Hospitals over 6 months on Patients who were mechanically ventilated for more than 48 hrs who were ready for weaning. Inclusion Criteria Patients intubated & mechanically ventilated for more than 48 hrs. Patients at their first SBT.Patients with adequate cough reflex. Patients fulfilling criteria of readiness for weaning from mechanical ventilation after resolution of cause of respiratory failure: Patients with score ranging between -1 and +1 on the Richmond Agitation and sedation scale (RASS). Exclusion criteria Age < 18 yrs. Patients with thoracotomy, pneumothorax, or pneumomediastinum. Patients with presence of flail chest or rib fractures. Patients with neuromuscular disease. Use of muscle-paralyzing agents within 48 hours before the study. History or new detection of paralysis or paradoxical movement of a single hemi diaphragm on diaphragmatic ultrasonography. Pregnant females. Unconscious noncooperative patients. Patients with intra-abdominal hypertension, Long term steroid therapy. Results I- Distribution of the studied patients regarding final outcome. II- Demographic data. III. Causes of MV. IV- Days on MV. V- Patients’ data and characteristics before start of weaning trial. VI- SBT Ventilator Breathing pattern after 30 min. VII- Study predictors. Conclusion D-RSBI is a new and promising tool that is superior to the traditional RSBI in predicting weaning outcome also MIP provides appreciated data with greater accuracy to assess inspiratory muscle strength and predicting weaning success in mechanically ventilated patients. Recommendations We could recommend the measurement of MIP and DRSBI as weaning predictors should be an integral part of evaluation of patients plan for weaning from MV. All intensivists should be acquitted with the use of U/S in the evaluation of diaphragmatic function.

Serial Measurements of the Rapid-Shallow-Breathing Index as a Predictor of Weaning Outcome in Elderly Medical Patients

CHEST Journal ◽  
1997 ◽  
Vol 112 (4) ◽  
pp. 1029-1034 ◽  
Author(s):  
Bruce P. Krieger ◽  
Jamal Isber ◽  
Albe Breitenbucher ◽  
Georgene Throop ◽  
Patti Ershowsky
Keyword(s):  
Medical Patients ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Weaning Outcome ◽  
Serial Measurements ◽  
Rapid Shallow Breathing

scholarly journals How Mechanical Ventilation Measurement, Cutoff and Duration Affect Rapid Shallow Breathing Index Accuracy: A Randomized Trial

2017 ◽  
Vol 9 (4) ◽  
pp. 289-296 ◽  
Author(s):  
Elaine Cristina Goncalves ◽  
Alessandra Fabiane Lago ◽  
Elaine Caetano Silva ◽  
Marcelo Barros de Almeida ◽  
Anibal Basile-Filho ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Randomized Trial ◽  
Rapid Shallow Breathing Index ◽  
Shallow Breathing ◽  
Rapid Shallow Breathing

scholarly journals Acupressure Improves the Weaning Indices of Tidal Volumes and Rapid Shallow Breathing Index in Stable Coma Patients Receiving Mechanical Ventilation: Randomized Controlled Trial

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Suh-Hwa Maa ◽  
Chiu-Hua Wang ◽  
Kuang-Hung Hsu ◽  
Horng-Chyuan Lin ◽  
Brian Yee ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Standard Care ◽  
Controlled Trial ◽  
Treatment Session ◽  
Randomized Controlled ◽  
Rapid Shallow Breathing Index ◽  
Respiratory Parameters ◽  
Shallow Breathing ◽  
The One ◽  
Rapid Shallow Breathing

Background. Acupressure has been shown to improve respiratory parameters. We investigated the effects of acupressure on weaning indices in stable coma patients receiving mechanical ventilation.Methods. Patients were randomly allocated to one of three treatments: standard care with adjunctive acupressure on one (n=32) or two days (n=31) and standard care (n=31). Acupressure in the form of 10 minutes of bilateral stimulation at five acupoints was administered per treatment session. Weaning indices were collected on two days before, right after, and at 0.5 hrs, 1 hr, 1.5 hrs, 2 hrs, 2.5 hrs, 3 hrs, 3.5 hrs, and 4 hrs after the start of treatment.Results. There were statistically significant improvements in tidal volumes and index of rapid shallow breathing in the one-day and two-day adjunctive acupressure study arms compared to the standard care arm immediately after acupressure and persisting until 0.5, 1 hr, and 2 hrs after adjustment for covariates.Conclusions. In the stable ventilated coma patient, adjunctive acupressure contributes to improvements in tidal volumes and the index of rapid shallow breathing, the two indices most critical for weaning patients from mechanical ventilation. These effects tend to be immediate and likely to be sustained for 1 to 2 hours.

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