Prospective assessment of the ability of rapid shallow breathing index computed during a pressure support spontaneous breathing trial to predict extubation failure in ICU

Objective: Assess change in ultrasound measures of diaphragm mechanics over the course of a 30-minute spontaneous breathing trial (SBT). Design: Prospective observational study. Setting: Single intensive care unit (Logan Hospital, Queensland, Australia), patients recruited from August 2016 to April 2018. Participants: Eligible patients were over the age of 18 years, ventilated for >24 hours, and planned to undergo an SBT. In total, 129 patients were screened. Main outcome measures: Ultrasound measures taken at 5 and 30 minutes during SBT: diaphragmatic excursion (DE), diaphragmatic thickening fraction (DTF), and diaphragmatic contraction speed (DCS). Diaphragmatic rapid shallow breathing index (DRSBI) was calculated using DE/respiratory rate. The presence of diaphragmatic dysfunction (DD) was also determined using DTF < 30%, DE < 11 mm, or DRSBI > 1.6. Results: Eighteen patients had ultrasound measures during an SBT. Four were unable to have DTF visualized. There was no significant change in DTF (n = 14, 32.41 ± 32.21 vs 23.19 ± 17.42, P = .33) or DE (n = 18, 1.72 ± 0.63 vs 1.66 ± 0.59, P = .63) over time. Diaphragmatic contraction speed increased over time (n = 18, 2.21 ± 1.25 vs 2.67 ± 1.61, P = .007). Diaphragmatic rapid shallow breathing index worsened over time (n = 18, 1.65 ± 1.02 vs 2.08 ± 1.51, P = .03). There was no significant change in the presence of DD. Diaphragmatic dysfunction by DTF 8/14 versus 10/14, by DE 4/18 versus 3/18, and by DRSBI 7/18 versus 9/18. No patients failed SBT and one patient failed extubation. Conclusions: Diaphragmatic mechanics may change over the course of an SBT. Further research is required to determine the clinical implications of these changes and the optimal timing of diaphragmatic ultrasound to predict weaning outcome. Diaphragmatic ultrasound may be less feasible than the published data suggest.

Download Full-text

Rapid Shallow Breathing Index Rate as a Predictor of Weaning Outcome During Spontaneous Breathing Trial: A Cohort Study

CHEST Journal ◽

10.1016/j.chest.2016.08.316 ◽

2016 ◽

Vol 150 (4) ◽

pp. 303A ◽

Cited By ~ 1

Author(s):

George Paul Habacon ◽

Edgardo Tiglao ◽

Teresita DeGuia ◽

William Del Poso ◽

Maria Encarnita Limpin

Keyword(s):

Cohort Study ◽

Spontaneous Breathing ◽

Spontaneous Breathing Trial ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Weaning Outcome ◽

Rapid Shallow Breathing

Download Full-text

Product of driving pressure and respiratory rate for predicting weaning outcomes

Journal of International Medical Research ◽

10.1177/03000605211010045 ◽

2021 ◽

Vol 49 (5) ◽

pp. 030006052110100

Author(s):

Ju Gong ◽

Bibo Zhang ◽

Xiaowen Huang ◽

Bin Li ◽

Jian Huang

Keyword(s):

Mechanical Ventilation ◽

Respiratory Rate ◽

Spontaneous Breathing ◽

Spontaneous Breathing Trial ◽

Plateau Pressure ◽

Driving Pressure ◽

Failure Group ◽

Rapid Shallow Breathing Index ◽

Weaning Failure ◽

Shallow Breathing

Objective Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning. Methods Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated. Results Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the success group and 230.2±52.2 cmH2O breaths/minute in the failure group. A DP×RR index >170.8 cmH2O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning. Conclusions Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure. Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3

Download Full-text

Validation of rapid shallow breathing index displayed by the ventilator compared to the standard technique in patients with readiness for weaning

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01680-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nuttapol Rittayamai ◽

Natwipha Ratchaneewong ◽

Pirat Tanomsina ◽

Withoon Kongla

Keyword(s):

Correlation Coefficient ◽

Spontaneous Breathing Trial ◽

Measurement Techniques ◽

Intraclass Correlation ◽

Standard Technique ◽

Time Points ◽

Average Value ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing

Abstract Background Rapid shallow breathing index (RSBI) is the most commonly used parameter for predicting weaning outcome. Measurement of RSBI by Wright spirometer (RSBIstandard) is the standard method in routine clinical practice. Data specific to the accuracy and reliability of the RSBI value displayed by the ventilator (RSBIvent) are scarce. Accordingly, this study aimed to evaluate the association between the average value of RSBIvent at different time points and RSBIstandard, and to assess the accuracy and reliability of these two RSBI measurement techniques. Methods This prospective cohort study included mechanically ventilated patients who were ready to wean. At the beginning of spontaneous breathing trial using the flow-by method, RSBI was measured by two different techniques at the same time, including: (1) Wright spirometer (breathing frequency/average tidal volume in 1 min) (RSBIstandard), and (2) the values displayed on the ventilator at 0, 15, 30, 45, and 60 s (RSBIvent). Results Forty-seven patients were enrolled. The RSBIvent value was significantly higher than the RSBIstandard value for every comparison. According to Spearman’s correlation coefficient (r) and intraclass correlation coefficient (ICC), the average value of RSBI from 5 time points (0, 15, 30, 45, and 60 s) showed the best correlation with the standard technique (r = 0.76 [P < 0.001], and ICC = 0.79 [95% CI 0.61–0.88], respectively). Bland–Altman plot also showed the best agreement between RSBIstandard and the RSBIvent value averaged among 5 time points (mean difference − 17.1 breaths/min/L). Conclusions We found that the ventilator significantly overestimates the RSBI value compared to the standard technique by Wright spirometer. The average RSBIvent value among 5 time points (0, 15, 30, 45, and 60 s) was found to best correlate with RSBIstandard.

Download Full-text

Determining the mechanical ventilation mode and pressure support combination that is best compatible with the rapid shallow breathing index calculated in spontaneous ventilation

Critical Care ◽

10.1186/cc13457 ◽

2014 ◽

Vol 18 (Suppl 1) ◽

pp. P267

Author(s):

S Demirtas Yilmaz ◽

G Gürsel ◽

M Aydogdu

Keyword(s):

Mechanical Ventilation ◽

Pressure Support ◽

Spontaneous Ventilation ◽

Ventilation Mode ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing

Download Full-text

Accuracy of a spontaneous breathing trial for extubation of neonates

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-200573 ◽

2020 ◽

pp. 1-8

Author(s):

M. Fiatt ◽

A.C. Bosio ◽

D. Neves ◽

R. Symanski da Cunha ◽

L.T. Fonseca ◽

...

Keyword(s):

Predictive Value ◽

Spontaneous Breathing ◽

Pressure Support ◽

Spontaneous Breathing Trial ◽

Invasive Mechanical Ventilation ◽

Newborn Infants ◽

Extubation Failure ◽

Great Accuracy ◽

Minimum Pressure ◽

Persistent Arterial Duct

BACKGROUND: Prevalence of extubation failure in neonates may be up to 80%, but evidence to determine if a neonate is ready for extubation remains unclear. We aim to evaluate a spontaneous breathing trial accuracy with minimum pressure support to predict success in neonates’ extubation and identify variables related to failures. METHODS: This is a diagnostic accuracy study based on a cohort study in an intensive care unit with all eligible newborn infants subjected to invasive mechanical ventilation for at least 24 hours submitted to the trial for 10 minutes before extubations. The outcome was failures of extubations, considered if reintubation was needed until 72 hours. RESULTS: The incidence of failure was 14.7%among 170 extubations. There were 145 successful extubations; of these, 140 also passed the trial with a sensitivity of 96.5%(95%CI: 92.1–98.9). Of the 25 extubations that eventually failed, 16 failed the test with a specificity of 64.0%(95%CI: 42.5–82.0). The negative predictive value was 76.2%, and the positive predictive value was 94%. In stratifying by weight, the accuracy was >98.7%for neonates weighting >2500 g, but 72.5%for those weighing <1250 g. Extubation failures occurred more frequently in smaller (p = 0.01), preterm infants (p = 0.17), with longer ventilation time (p = 0.05), and having a hemodynamically significant persistent arterial duct (p = 0.01), compared with infants whose extubation was successful. CONCLUSION: The spontaneous breathing trial with minimum pressure support ventilation seems to predict extubation success with great accuracy in full-term and larger neonates.

Download Full-text

Predictors of extubation failure after open-chest cardiac surgery based on routinely collected data. The importance of a shared interprofessional clinical assessment

European Journal of Cardiovascular Nursing ◽

10.1177/1474515118782103 ◽

2018 ◽

Vol 17 (8) ◽

pp. 751-759 ◽

Cited By ~ 1

Author(s):

Gianfranco Sanson ◽

Massimiliano Sartori ◽

Lorella Dreas ◽

Roberta Ciraolo ◽

Adam Fabiani

Keyword(s):

Cardiac Surgery ◽

Length Of Stay ◽

Invasive Mechanical Ventilation ◽

Extubation Failure ◽

Hospital Length ◽

Neurological Function ◽

Hospital Length Of Stay ◽

Rapid Shallow Breathing Index ◽

Shallow Breathing ◽

Rapid Shallow Breathing

Background: Extubation failure (ExtF) is associated with prolonged hospital length of stay and mortality in adult cardiac surgery patients postoperatively. In this population, ExtF-related variables such as the arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2), rapid shallow breathing index, cough strength, endotracheal secretions and neurological function have been sparsely researched. Aim: To identify variables that are predictive of ExtF and related outcomes. Method: Prospective observational longitudinal study. Consecutively presenting patients ( n=205) undergoing open-heart cardiac surgery and admitted to the Cardiosurgical Intensive Care Unit (CICU) were recruited. The clinical data were collected at CICU admission and immediately prior to extubation. ExtF was defined as the need to restart invasive or non-invasive mechanical ventilation while the patient was in the CICU. Results: The ExtF incidence was 13%. ExtF related significantly to hospital mortality, CICU length of stay and total hospital length of stay. The risk of ExtF decreased significantly, by 93% in patients with good neurological function and by 83% in those with a Rapid Shallow Breathing Index of ≥57 breaths/min per litre. Conversely, ExtF risk increased 27 times when the PaO2/FiO2 was <150 and 11 times when it was ≥450. Also, a reassuring PaO2/FiO2 value may hide critical pulmonary or extra-pulmonary conditions independent from alveolar function. Conclusion: The decision to extubate patients should be taken after thoroughly discussing and combining the data derived from nursing and medical clinical assessments. Extubation should be delayed until the patient achieves safe respiratory, oxygenation and haemodynamic conditions, and good neurocognitive function.

Download Full-text