Rapid Shallow Breathing (Frequency-Tidal Volume Ratio) Did Not Predict Extubation Outcome

Lee, Kang H.; Hui, K P; Chan, Tiong Beng; Tan, Wan C.; Lim, Tow Keang

doi:10.1378/chest.105.2.540

Cited by 177 publications

(72 citation statements)

References 21 publications

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“…However, it was found in some studies that RSBI did not have enough efficiency during its routine use for weaning, especially during prolonged MV. The most suitable RSBI value was measured as 97 in one study that evaluated the efficiencies of the weaning parameters, but the accuracy of Yang and Tobin's index (RSBI) with a threshold value of 105 was found to be only 59% in patients with prolonged MV (9,17,18). Similarly in our study, there was prolonged MV for most of our patients.…”

Section: Yılmaz Et Al Rapid Shallow Breathing Index In Different Precontrasting

confidence: 59%

Determining The Pressure Combination During Mechanical Ventilation that is Best Compatible with the Rapid Shallow Breathing Index Calculated in Spontaneous Ventilation

Yılmaz¹,

Aydoğdu²,

Gürsel³

2017

Eurasian J Pulmonol

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Weaning is the process of decreasing ventilator support and allowing patients to assume a greater proportion of their spontaneous ventilation with the gradual reduction of ventilator support (1). In order to predict the patients' success in maintaining their spontaneous breathing and oxygenation, some parameters have been researched. Among these, the rapid shallow breathing index (RSBI) is the most studied and most accepted system with the highest predictive value (2, 3).Rapid shallow breathing index, the ratio of respiratory rate to tidal volume (f/VT), was first described by Yang and Tobin in 1990, as a parameter for weaning and extubation. A RSBI greater than 105 means that the patient is not ready for weaning off the ventilator (4). Moreover, a RSBI of less than 100-105 has yielded a sensitivity of 97% and a specificity of 65% for predicting weaning success (3). The evaluation of RSBI is valuable during T-tube ventilation; and in clinical practice it is not always possible to perform this assessment.In the present study, we aimed to estimate the patients' readiness toward weaning and to determine the pressure combination that is best compatible with the RSBI calculated by the original method, in which the measurement was done during no ventilator support. METHODS Patient PopulationIn this self-controlled and prospective study, the patients mechanically ventilated in an intensive care unit (ICU) were included in the study. The diagnosis of the patients and the underlying etiologies of their mechanical ventilation (MV) need were recorded. Ventilators were calibrated prior to intubation and then appropriate mechanical ventilator settings were done according to each patient's need. All the patients' age, gender, comorbid diseases, smoking history, diagnosis of intubation, intubation and extubation days, weaning trial day, weaning success, length of hospitalization, length of MV and ICU stay, need for re-intubation, outcome (exitus or discharge to home/ ward), and causes of mortality were recorded.

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Section: Yılmaz Et Al Rapid Shallow Breathing Index In Different Precontrasting

confidence: 59%

Determining The Pressure Combination During Mechanical Ventilation that is Best Compatible with the Rapid Shallow Breathing Index Calculated in Spontaneous Ventilation

Yılmaz¹,

Aydoğdu²,

Gürsel³

2017

Eurasian J Pulmonol

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“…Good reproducibility of classical weaning parameters with similar bedside techniques was demonstrated, especially when indexes that estimate the ventilatory pattern using V T and respiratory rate, such as the Tobin index, which is deemed to be the most accurate to predict the prognosis of wean [11][12][13] , were evaluated. Although the accuracy of this index is better than the other extubation tests frequently used [14][15][16][17][18][19] , 20% of false positive results were observed, i.e., the relationship f/V T predicted a successful extubation but the patient could not maintain adequate ventilatory autonomy and had to be re-intubated, or presented clinical complications related with the extubation process [20][21][22][23][24] . The objective of this study was to evaluate the use of the Tobin index with values between 80 and 100 c.L -1 .min -1 or lower than 80 c.L -1 .min -1 before extubation in patients undergoing general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Demonstrou-se boa reprodutibilidade de parâmetros clás-sicos de desmame realizados com técnicas corretas à beira do leito, sobretudo quando foram avaliados os índices que estimam o padrão ventilatório com o VCE e a freqüência respiratória, como o índice de Tobin, apontado como um dos parâmetros com maior acurácia em predizer o prognóstico do desmame ventilatório [11][12][13] . Embora a precisão desse ín-dice seja melhor do que os demais testes de extubação mais utilizados [14][15][16][17][18][19] foram observados 20% de resultados falsos-positivos, isto é, a relação f/VCE prediz sucesso na extubação, porém o paciente não consegue manter autonomia ventilatória adequada, necessitando de reintubação, ou, então, apresenta complicações clínicas relacionadas com o processo de extubação [20][21][22][23][24] . O objetivo deste estudo foi avaliar a aplicação do índice de Tobin com valores entre 80 e 100 c.L -1 .min -1 ou menores que 80 c.L -1 .min -1 antes da extubação traqueal em pacientes submetidos a anestesia geral.…”

Section: Introductionunclassified

Avaliação da aplicação do índice de tobin no desmame da ventilação mecânica após anestesia geral

Mantovani

Zuliani

Sano

et al. 2007

Rev. Bras. Anestesiol.

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JUSTIFICATIVA E OBJETIVO:O índice preditivo de descontinuação da ventilação mecânica é parâmetro de prognóstico de desmame. O objetivo deste estudo foi avaliar a aplicação do índi-ce de Tobin antes da extubação traqueal em pacientes submetidos à anestesia geral. MÉTODO:Foram analisados 80 pacientes, 40 (50%) homens e 40 (50%) mulheres submetidos a colecistectomia sob anestesia geral. A média de idade foi 57,7 ± 12,4 (33 a 82 anos) e a média do peso corpóreo foi 70,85 ± 11,07 (48 a 90 kg). Trinta e sete (46,2%) pacientes eram tabagistas. O índice de Tobin foi obtido pela relação entre freqüência respiratória e volume corrente em ciclos/litro/minuto (c.L -1 .min -1 ). Foram estudadas as variáveis: idade, peso, tabagismo, risco anestésico-cirúrgico, duração do procedimento, volume corrente expirado e freqüência respiratória pós-operatória, tempo de permanência na recuperação pós-anestésica, ocorrências clínicas intra-operatórias e gravidade das ocorrências clínicas após extubação. Foram utilizados testes estatísticos paramétricos e não-paramétricos, e análise de regressão logística univariada e múltipla. RESULTADOS: BACKGROUND AND OBJECTIVES:The predictive index for discontinuing mechanical ventilation is a prognostic parameter. The objective of this study was to evaluate the use of the Tobin index before tracheal extubation in patients undergoing general anesthesia. METHODS:Eighty patients, 40 (50%) men and 40 (50%) women undergoing cholecystectomy under general anesthesia were analyzed. The mean age of the patients was 57.7 ± 12.4 (33 to 82 years) and mean body weight was 70.85 ± 11.07 (48 to 90 kg). Thirtyseven patients (46.2%) were smokers. The Tobin index was obtained through the relationship between respiratory rate and tidal volume in cycles/Liter/minute (c.L -1 .min -1 ). Age, weight, smoking, anesthetic-surgical risk, duration of the procedure, expired tidal volume, and postoperative respiratory rate, length of time in the recovery room, intraoperative clinical intercurrences and severity of the clinical intercurrences after extubation were studied. Parametric and non-parametric statistical tests, and analysis of univariate and multiple logistic regression were used. RESULTS:Age (p = 0.019), body weight (p = 0.006), smoking (p = 0.014), anesthetic risk (p = 0.0001), tidal volume (p < 0.0001), respiratory rate (p < 0.0001), length of time in the recovery room (p < 0.0001), and post-extubation clinical intercurrences (p < 0.0001) had a significant influence in the Tobin index. The independent variables with risk of failure to wean included advanced age and elevated body weight (p = 0.023). CONCLUSIONS:Weaning patients off mechanical ventilation in the postoperative period with a Tobin Index ≥ 80 c.L -1 .min -1 and < 100 c.L -1 .min -1 was associated with elevated risk of postoperative clinical intercurrences after extubation. Patients with a Tobin index ≥ 80 c.L -1 .min, advanced age and increased body weight were independent variables of risk of failure to discontinue mechanical ventilation.

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“…64 In automated weaning, arbitrarily defined zones of respiratory comfort are identified for tidal volume and frequency. 63,65 However, many ventilated patients have diseases or chronic conditions that violate these assumptions. 66 For example, a patient with severe kyphoscoliosis may have a high baseline frequency/tidal volume ratio perfectly compatible with adequate compensation.…”

Section: Is Automated Weaning Superior To Manual Spontaneous Trials? Nomentioning

confidence: 99%

Is Automated Weaning Superior to Manual Spontaneous Breathing Trials?

Holets

Marini

2016

Respir Care

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Weaning from mechanical ventilation involves the reduction or withdrawal of ventilatory support in proportion to the patient's ability to sustain spontaneous ventilation. Protocolized weaning has been shown to reduce weaning duration; however, its weakness lies in the reliance on human intervention. Automated weaning is theoretically superior to manual weaning because of its ability to rapidly recognize deviations from desired behavior and enforce compliance with a standardized weaning strategy unencumbered by external influences. Whether currently available methods for automated weaning fulfill that potential to achieve superiority depends on patient type, care environment, and cause of ventilator dependence.

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Rapid Shallow Breathing (Frequency-Tidal Volume Ratio) Did Not Predict Extubation Outcome

Cited by 177 publications

References 21 publications

Determining The Pressure Combination During Mechanical Ventilation that is Best Compatible with the Rapid Shallow Breathing Index Calculated in Spontaneous Ventilation

Determining The Pressure Combination During Mechanical Ventilation that is Best Compatible with the Rapid Shallow Breathing Index Calculated in Spontaneous Ventilation

Avaliação da aplicação do índice de tobin no desmame da ventilação mecânica após anestesia geral

Is Automated Weaning Superior to Manual Spontaneous Breathing Trials?

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