A rapid shallow breathing index threshold of 85 best predicts extubation success in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure

Abstract

Background: The rapid shallow breathing index (RSBI) is used clinically to help predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the traditional threshold (<105 breaths/min/L) may underperform in patients with chronic obstructive pulmonary disease (COPD).We sought to determine the optimal RSBI threshold for COPD patients to improve the diagnostic accuracy for predicting successful ventilator liberation. Methods: This was a prospective observational multicenter study of COPD patients [according to Global initiative for Chronic Obstructive Lung Disease (GOLD) criteria] admitted to the Medical ICUs of eight academic medical centers. All patients were intubated for hypercapnic respiratory failure and met the American Thoracic Society/European Respiratory Society guidelines to participate in a weaning trial. Ventilator weaning was conducted according to a defined protocol. RSBI was measured through the ventilator after 120 minutes of spontaneous breathing trial (SBT). Results: Ninety patients were included (39 males and 51 females). Forty-three patients (48%) were successfully extubated whereas 47 patients (52%) failed extubation. Significant differences were observed between groups for duration-of-intubation [duration of intubation (DoI); P<0.0001], spontaneous tidal volume (VT) (P=0.03), and the ratio of dynamic-to-static compliance (P=0.005). The RSBI threshold of ≤85 breaths/min/L performed best: area under curve (AUC) receiver operating characteristic (ROC) curves 0.91, sensitivity 95.6%, specificity 90.4%, positive predictive value (PPV) 95.5%, and negative predictive value (NPV) 90.6%., positive likelihood ratio (LR+) 5.48, negative likelihood ratio (LR−) 0.25, and the diagnostic accuracy 91.7%. In post-ROC analyses, DoI and hospital length-of-stay (LOS) did not impact performance. Conclusions: In COPD patients intubated with hypercapnia, RSBI ≤85 breaths/min/L outperformed the widely used threshold <105 breaths/min/L, yielding a 95.5% probability of extubation success, independent 1224

Clinical study of Dysfunctional Ventilatory Weaning Response in critically ill patients

“…Nevertheless, there was no statistical difference between the age group and the occurrence of DVWR (p<0.05). However, a statistical association was observed between the mean age and the occurrence of DVWR ( p =0.02), which corroborates the findings reported by previous investigations ( 25 , 28 - 29 ) . The association can be partially explained by the morphological and functional changes that occur in the respiratory system with aging, in addition to the greater number of comorbidities in this population.…”

Independent Risk Factors of Failed Extubation among Adult Critically Ill Patients: A Prospective Observational Study from Saudi Arabia

“…[ 16 ] Rapid respiratory rate at the time of extubation could also be a culprit of extubation failure, as it is usually ends in respiratory muscles’ fatigue that may eventually lead to respiratory failure and the need to reinstitute mechanical ventilation. [ 17 ] It logically follows that a lower pH may be a sign of respiratory muscle weakness, and suboptimal breathing rate and depth, thereby contributing to the risk of extubation failure. Gobert et al .…”

Disease specific thresholds for determining extubation readiness: The optimal negative inspiratory force for chronic obstructive pulmonary disease patients

“…The RSBI is among the most commonly used indices in non-homogeneous populations for predicting successful ventilator liberation. [ 38 48 49 50 ] The accuracy of this measurement, however, has been questioned in the setting of sepsis, fever, supine position, restrictive physiology, and patient anxiety. [ 51 ] One study reported that including the RSBI into a weaning protocol after a decision was made to attempt an SBT prolonged weaning and IMV for an additional day without reducing the number of failed extubations or tracheostomy placements.…”

“…[ 55 56 ] Moreover, in the COPD population, an RSBI threshold of ≤85 breaths/min/L outperformed the widely used threshold <105 breaths/min/L, yielding a 95.5% probability of extubation success. [ 50 ]…”