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Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients

BACKGROUND: Rapid shallow breathing index (RSBI) has been widely used as a predictor of extubation outcome in mechanically ventilated patients. We hypothesize that the rate of change of RSBI between the beginning and end of a 120-minute spontaneous breathing trial (SBT) could be a better predictor o...

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Autores principales: Karthika, Manjush, Al Enezi, Farhan A., Pillai, Lalitha V., Arabi, Yaseen M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547562/
https://www.ncbi.nlm.nih.gov/pubmed/37795474
http://dx.doi.org/10.1155/2023/9141441
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author Karthika, Manjush
Al Enezi, Farhan A.
Pillai, Lalitha V.
Arabi, Yaseen M.
author_facet Karthika, Manjush
Al Enezi, Farhan A.
Pillai, Lalitha V.
Arabi, Yaseen M.
author_sort Karthika, Manjush
collection PubMed
description BACKGROUND: Rapid shallow breathing index (RSBI) has been widely used as a predictor of extubation outcome in mechanically ventilated patients. We hypothesize that the rate of change of RSBI between the beginning and end of a 120-minute spontaneous breathing trial (SBT) could be a better predictor of extubation outcome than a single RSBI measured at the end of SBT in mechanically ventilated patients. Methodology. In this prospective observational study, we enrolled 193 patients who met the inclusion criteria, of whom 33 patients were unable to tolerate a 120-minute SBT and were excluded from the study. The study population consisted of 160 patients, categorized into three subgroups: patients with normal lung (no reported history of respiratory diseases), patients with airway disease, and patients with parenchymal disease who completed 120 minutes of SBT on low levels of pressure support ventilation. RSBI was obtained from the ventilator display at the 5(th) and the 120(th) minutes of SBT. The rate of change of RSBI (RSBI 5–120) was calculated as (RSBI 2-RSBI 1)/RSBI 1 × 100. Receiver-operating characteristic (ROC) curves were plotted for RSBI 5–120 and RSBI 120 in all patients and among the three subgroups (normal group, airway group, and parenchymal group) to compare the superiority of their best thresholds in predicting extubation failure. RESULTS: The RSBI 5–120 threshold for extubation failure in the entire patient group was 23% with an overall accuracy of 88% (AUC = 0.933, sensitivity = 91%, and specificity = 86%) and the threshold of RSBI 120 for extubation failure in the entire patient group was 70 breaths/min/L with an overall accuracy of 82% (AUC = 0.899, sensitivity = 85%, and specificity = 81%). In patients in the normal lung group, the threshold of RSBI 5–120 was 22%, with an overall accuracy of 89% (AUC = 0.892, sensitivity = 87.5%, and specificity = 90%), and the RSBI 120 threshold was 70 breaths/min/L, with an overall accuracy of 89% (AUC = 0.956, sensitivity = 88%, and specificity = 90%). The RSBI 5–120 threshold in patients with airway disease was 25% with an accuracy of 86% (AUC = 0.892, sensitivity = 85%, and specificity = 86%) and the threshold of RSBI 120 was 73 breaths/min/L with an accuracy of 83% (AUC = 0.874, sensitivity = 85%, and specificity = 82%). In patients in the parenchymal disease group, the threshold of RSBI 5–120 was 24%, with an accuracy of 90% (AUC = 0.966, sensitivity = 92%, and specificity = 89%) and RSBI 120 threshold was 71 breaths/min/L, which was 88% accurate (AUC = 0.893, sensitivity = 85%, and specificity = 89%). CONCLUSION: The rate of change of RSBI between the 5(th) and 120(th) minutes was moderately more accurate than the single value of RSBI measured at the 120(th) minute in predicting extubation outcome.
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spelling pubmed-105475622023-10-04 Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients Karthika, Manjush Al Enezi, Farhan A. Pillai, Lalitha V. Arabi, Yaseen M. Crit Care Res Pract Research Article BACKGROUND: Rapid shallow breathing index (RSBI) has been widely used as a predictor of extubation outcome in mechanically ventilated patients. We hypothesize that the rate of change of RSBI between the beginning and end of a 120-minute spontaneous breathing trial (SBT) could be a better predictor of extubation outcome than a single RSBI measured at the end of SBT in mechanically ventilated patients. Methodology. In this prospective observational study, we enrolled 193 patients who met the inclusion criteria, of whom 33 patients were unable to tolerate a 120-minute SBT and were excluded from the study. The study population consisted of 160 patients, categorized into three subgroups: patients with normal lung (no reported history of respiratory diseases), patients with airway disease, and patients with parenchymal disease who completed 120 minutes of SBT on low levels of pressure support ventilation. RSBI was obtained from the ventilator display at the 5(th) and the 120(th) minutes of SBT. The rate of change of RSBI (RSBI 5–120) was calculated as (RSBI 2-RSBI 1)/RSBI 1 × 100. Receiver-operating characteristic (ROC) curves were plotted for RSBI 5–120 and RSBI 120 in all patients and among the three subgroups (normal group, airway group, and parenchymal group) to compare the superiority of their best thresholds in predicting extubation failure. RESULTS: The RSBI 5–120 threshold for extubation failure in the entire patient group was 23% with an overall accuracy of 88% (AUC = 0.933, sensitivity = 91%, and specificity = 86%) and the threshold of RSBI 120 for extubation failure in the entire patient group was 70 breaths/min/L with an overall accuracy of 82% (AUC = 0.899, sensitivity = 85%, and specificity = 81%). In patients in the normal lung group, the threshold of RSBI 5–120 was 22%, with an overall accuracy of 89% (AUC = 0.892, sensitivity = 87.5%, and specificity = 90%), and the RSBI 120 threshold was 70 breaths/min/L, with an overall accuracy of 89% (AUC = 0.956, sensitivity = 88%, and specificity = 90%). The RSBI 5–120 threshold in patients with airway disease was 25% with an accuracy of 86% (AUC = 0.892, sensitivity = 85%, and specificity = 86%) and the threshold of RSBI 120 was 73 breaths/min/L with an accuracy of 83% (AUC = 0.874, sensitivity = 85%, and specificity = 82%). In patients in the parenchymal disease group, the threshold of RSBI 5–120 was 24%, with an accuracy of 90% (AUC = 0.966, sensitivity = 92%, and specificity = 89%) and RSBI 120 threshold was 71 breaths/min/L, which was 88% accurate (AUC = 0.893, sensitivity = 85%, and specificity = 89%). CONCLUSION: The rate of change of RSBI between the 5(th) and 120(th) minutes was moderately more accurate than the single value of RSBI measured at the 120(th) minute in predicting extubation outcome. Hindawi 2023-09-26 /pmc/articles/PMC10547562/ /pubmed/37795474 http://dx.doi.org/10.1155/2023/9141441 Text en Copyright © 2023 Manjush Karthika et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Karthika, Manjush
Al Enezi, Farhan A.
Pillai, Lalitha V.
Arabi, Yaseen M.
Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients
title Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients
title_full Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients
title_fullStr Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients
title_full_unstemmed Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients
title_short Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients
title_sort rate of change of rapid shallow breathing index and extubation outcome in mechanically ventilated patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10547562/
https://www.ncbi.nlm.nih.gov/pubmed/37795474
http://dx.doi.org/10.1155/2023/9141441
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