What is the Optimal Cutoff Point of Rapid Shallow Breathing Index Calculated by the Mechanical Ventilator Parameters? A Retrospective Observational Study

  • İbrahim Mungan Türkiye yüksek ihtisas hastanesi, yogun bakım kliniği
  • Şerife Bektaş Türkiye yüksek ihtisas hastanesi, yogun bakım kliniği
  • Sema Sarı Türkiye yüksek ihtisas hastanesi, yogun bakım kliniği
  • Sema Turan Türkiye yüksek ihtisas hastanesi, yogun bakım kliniği

Abstract

Background: The discontinuance of mechanical ventilatory support (MVS) is identified as weaning and weaning process is started whenever escalating factor for respiratory failure resolves. Although all weaning criteria were fulfilled, 20% of weaning attempts were unsuccessful. The Rapid Shallow Breathing Index is one of the most studied indices. In this study, we aimed to find out the optimal cutoff point of the RSBI measured in MVS. Methods: This retrospective, non-interventional cohort study was conducted at a tertiary care hospital in Ankara, Türkiye. After collecting all data, the study population was divided into two group according to weaning failure (WF). Statistical analysis included Mann Whitney U-test, Youden index, and ROC-curves to predict WF. Results: 46 patients fulfilled the inclusion criteria, and nine patients could not tolerate extubation and required reintubation [WF (+)group, 19.5%] within 72 hours. Not only the RSBI but also the other parameters like Static compliance (Cstat) and PaO2/FiO2 differed among groups. In this study, the discriminative power which was appraised using the AUC was high enough with RSBI (AUC= 0.962). Conclusion: MVS may decrease RSBI and lower predictive value in classical original cutoff point (105). However, the discriminative power with 40 as the threshold level was proven to be effective in our study.

References

Baptistella AR, Sarmento FJ, da Silva KR, Baptistella SF, Taglietti M, Zuquello RÁ, NunesFilho JR. Predictive factors of weaning from mechanical ventilation and extubation outcome: A systematic review. J CritCare. 2018 Aug 20;48:56-62.

doi: 10.1016/j.jcrc.2018.08.023.

Forgiarini SGI, Rosa DPD, Forgiarini LF, Teixeira C, Andrade F, Forgiarini Junior LA, Felix EA, Friedman G. Evaluation of systemic inflammation in patients being weaned from mechanical ventilation. Clinics (Sao Paulo). 2018;73:e256.

doi: 10.6061/clinics/2018/e256.

Lai C.C.,Chen C.M., Chiang S.R., Liu W.L., Weng S.F., Sung M.I., Hsing S.C., Cheng K.C. Establishing predictors for successfully planned endotracheal extubation. Medicine. 2016;95:48–53. doi: 10.1097/MD.0000000000004852

Goncalves EC, Lago AF, Silva EC, de Almeida MB, Basile-Filho A, Gastaldi AC. How Mechanical Ventilation Measurement, Cutoff and Duration Affect Rapid Shallow Breathing Index Accuracy: A Randomized Trial. J Clin Med Res. 2017;9(4):289-296. doi:10.14740/jocmr2856w.

Tu CS, Chang CH, Chang SC, Lee CS, Chang CT. A Decision for Predicting Successful Extubation of Patients in Intensive Care Unit. Biomed Res Int. 2018 Jan 4; 2018:6820975. doi: 10.1155/2018/6820975. eCollection 2018.

Boles JM, Bion J, Connors A, Herridge M, Marsh B, Melot C, Pearl R, Silverman H, Stanchina M, Vieillard-Baron A, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29(5):1033–1056. doi: 10.1183/09031936.00010206.

Yang PH, Hung JY, Yang CJ, Tsai JR, Wang TH, Lee JC, Huang MS. Successful weaning predictors in a respiratory care center in Taiwan. Kaohsiung J Med Sci. 2008;24:85–91. doi: 10.1016/S1607-551X(08)70102-5

Karthika M, Al Enezi FA, Pillai LV, Arabi YM. Rapid shallow breathing index. Annals of Thoracic Medicine. 2016;11(3):167-176. doi:10.4103/1817-1737.176876.

Santos Lde O, Borges MR, Figueiredo LC, Guedes CA, Vian BS, Kappaz K, Araujo S. Comparison among three methods to measure the rapid shallow breathing index in patients submitted to weaning from mechanical ventilation. Rev Bras Ter Intensiva. 2007;19(3):331-336. doi: 10.1016/j.jcrc.2012.09.002

Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991;324(21):1445-50. doi:10.1056/NEJM199105233242101

De Souza LC, Lugon JR. The rapid shallow breathing index as a predictor of successful mechanical ventilation weaning: clinical utility when calculated from ventilator data. Jornal Brasileiro de Pneumologia. 2015;41(6):530-535. doi:10.1590/S1806-37132015000000077.

Patel KN, Ganatra KD, Bates JH, Young MP. Variation in the rapid shallow breathing index associated with common measurement techniques and conditions. Respir Care. 2009;54(11):1462-6.

Goncalves EC, Silva EC, Basile Filho A, Auxiliadora-Martins M, Nicolini EA, Gastaldi AC. Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation. Rev Bras Fisioter. 2012;16(5):368–374. doi: 10.1590/S1413-35552012005000037.

Kheir F, Myers L, Desai NR, Simeone F. The effect of flow trigger on rapid shallow breathing index measured through the ventilator. J Intensive Care Med. 2015;30(2):103-6. doi:org/10.1177/0885066613504538

Jeganathan N, Kaplan C, Balk R. Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial. Respiratory Care Feb 2015, 60 (2) 290-296; doi: 10.4187/respcare.03111

Esteban A, Alía I, Gordo F, Fernández R, Solsona JF, Vallverdú I, et al. Extubation outcome after spontaneous breathing trials with T-tube or Pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997;156(2 Pt1):459-65. doi:10.1164/ajrccm.156.2.9610109.

Hsieh M-H, Hsieh M-J, Chen C-M, Hsieh C-C, Chao C-M, Lai C-C. An Artificial Neural Network Model for Predicting Successful Extubation in Intensive Care Units. Journal of Clinical Medicine. 2018;7(9):240. doi:10.3390/jcm7090240.

Lessa FA, Paes CD, Tonella RM, Araujo S. Comparison of the rapid shallow breathing index (RSBI) calculated under direct and indirect form on the postoperative period of cardiac surgery. Rev Bras Fisioter. 2010;14(6):503–509. doi: 10.1590/S1413-35552010000600009.

Güntzel Chiappa AM, Chiappa GR, Cipriano G Jr, Moraes RS, Ferlin EL, Borghi-Silva A, Vieira SR. Spontaneous breathing trial in T-tube negatively impact on autonomic modulation of heart rate compared with pressure support in critically ill patients.Clin Respir J. 2017 Jul;11(4):489-495. doi: 10.1111/crj.12363. Epub 2015 Sep 18.

DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing areas under two or more correlated reciever operating characteristics curves: a nonparamentric approach. Biometrics. 1988;44(3):837–845.

de Souza LC, Guimarães FS, Lugon JR. Evaluation of a new index of mechanical ventilation weaning: the timed inspiratory effort. J Intensive Care Med. 2015;30(1):37-43. http://dx.doi.org/10.1177/0885066613483265

Corbellini C, Trevisan CBE, Villafañe JH, Doval da Costa A, Vieira SRR. Weaning from mechanical ventilation: a cross-sectional study of reference values and the discriminative validity of aging. Journal of Physical Therapy Science. 2015;27(6):1945-1950. doi:10.1589/jpts.27.1945.

Takaki S, Kadiman SB, Tahir SS, Ariff MH, Kurahashi K, Goto T. Modified rapid shallow breathing index adjusted with anthropometric parameters increases predictive power for extubation failure compared with the unmodified index in postcardiac surgery patients. J Cardiothorac Vasc Anesth. 2015;29(1):64-8. http://dx.doi.org/10.1053/j.jvca.2014.06.022

Spadaro S, Grasso S, Mauri T, et al. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Crit Care 2016;20:305–16. doi:10.1186/s13054-016-1479-y

Fadaii A, Amini S. S, Bagheri B, Taherkhanchi B. Assessment of Rapid Shallow Breathing Index as a Predictor for Weaning in Respiratory Care Unit. Tanaffos. 2012;11:28–31.

Shingala H, Abouzgheib W, Darrouj J, Pratter M. Comparison of rapid shallow breathing index measured on pressure support ventilation and spontaneous breathing trial to predict weaning from mechanical ventilation. Chest. 2009;136:32S.

doi:10.1378/chest.136.4_MeetingAbstracts.32S-a

Youssef HAA, Shalaby AEO, El Hafiz AMA,Shaban MM, Hamed HA. Predictive value of rapid shallow breathing index in relation to the weaning outcome in ICU patients. Egyptian Journal of Chest Diseases and Tuberculosis. 2016;65(2):465-72. https://doi.org/10.1016/j.ejcdt.2016.01.009

Frutos-Vivar F, Esteban A, Apezteguia C, González M, Arabi Y, Restrepo MI, et al. Outcome of reintubated patients after scheduled extubation. J Crit Care. 2011;26(5):502–509. doi: 10.1016/j.jcrc.2010.12.015.

Hosseini M, Ramazani J. Evaluation of acute physiology and chronic health evaluation II and sequential organ failure assessment scoring systems for prognostication of outcomes among intensive care unit’s patients. Saudi J Anaesth 2016;10:168–73. doi: 10.4103/1658-354X.168817

Published
2020-09-12
Section
Original Research