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Ada Clarice Gastaldi - One of the best experts on this subject based on the ideXlab platform.
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how mechanical ventilation measurement cutoff and duration affect rapid Shallow Breathing index accuracy a randomized trial
Journal of Clinical Medicine Research, 2017Co-Authors: Elaine C Goncalves, Alessandra Fabiane Lago, Elaine C Silva, Marcelo Barros De Almeida, Anibal Basilefilho, Ada Clarice GastaldiAbstract:Background: Decreased accuracy of the rapid Shallow Breathing index (RSBI) can stem from 1) the method used to obtain this index, 2) duration of mechanical ventilation (MV), and 3) the established cutoff point. The objective was to evaluate the values of RSBI determined by three different methods, using distinct MV times and cutoff points. Methods: This prospective study included 40 subjects. Before extubation, three different methods were employed to measure RSBI: pressure support ventilator (PSV) (PSV = 5 - 8 cm H 2 O; positive end-expiratory pressure (PEEP) = 5 cm H 2 O) (RSBI_MIN), automatic tube compensation (ATC) (PSV = 0, PEEP = 5 cm H 2 O, and 100% tube compensation) (RSBI_ATC), and disconnected MV (RSBI_SP). The results were analyzed according to the MV period (less than or over 72 h) and to the outcome of extubation ( 72 h successful and failed). The accuracy of each method was determined at different cutoff points (105, 78, and 50 cycles/min/L). Results: The RSBI_MIN, RSBI_ATC, and RSBI_SP values in the group 72 h, RSBI_SP value was higher than those of RSBI_ATC and RSBI_MIN (78 ± 29, 51 ± 19 and 39 ± 14) (P 72 h who failed in removing MV, the RSBI_SP was higher (93 ± 28, 58 ± 18 and 41 ± 10) (P < 0.000), with greater accuracy at cutoff of 78. Conclusion: RSBI_SP associated with cutoff point < 78 cycles/min/L seems to be the best strategy to identify failed extubation in subjects with MV for over 72 h. J Clin Med Res. 2017;9(4):289-296 doi: https://doi.org/10.14740/jocmr2856w
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low pressure support changes the rapid Shallow Breathing index rsbi in critically ill patients on mechanical ventilation
Revista Brasileira De Fisioterapia, 2012Co-Authors: Elaine C Goncalves, Elaine C Silva, Anibal Basile Filho, Maria Auxiliadoramartins, Edson Antonio Nicolini, Ada Clarice GastaldiAbstract:BACKGROUND: The rapid Shallow Breathing index (RSBI) is the most widely used index within intensive care units as a predictor of the outcome of weaning, but differences in measurement techniques have generated doubts about its predictive value. OBJECTIVE: To investigate the influence of low levels of pressure support (PS) on the RSBI value of ill patients. METHOD: Prospective study including 30 patients on mechanical ventilation (MV) for 72 hours or more, ready for extubation. Prior to extubation, the RSBI was measured with the patient connected to the ventilator (DragerTM Evita XL) and receiving pressure support ventilation (PSV) and 5 cmH2O of positive end expiratory pressure or PEEP (RSBI_MIN) and then disconnected from the VM and connected to a Wright spirometer in which respiratory rate and exhaled tidal volume were recorded for 1 min (RSBI_ESP). Patients were divided into groups according to the outcome: successful extubation group (SG) and failed extubation group (FG). RESULTS: Of the 30 patients, 11 (37%) failed the extubation process. In the within-group comparison (RSBI_MIN versus RSBI_ESP), the values for RSBI_MIN were lower in both groups: SG (34.79±4.67 and 60.95±24.64) and FG (38.64±12.31 and 80.09±20.71; p<0.05). In the between-group comparison, there was no difference in RSBI_MIN (34.79±14.67 and 38.64±12.31), however RSBI_ESP was higher in patients with extubation failure: SG (60.95±24.64) and FG (80.09±20.71; p<0.05). CONCLUSIONS: In critically ill patients on MV for more than 72h, low levels of PS overestimate the RSBI, and the index needs to be measured with the patient Breathing spontaneously without the aid of pressure support.
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baixos niveis de pressao de suporte alteram o indice de respiracao rapida e superficial irrs em pacientes graves sob ventilacao mecânica low pressure support changes the rapid Shallow Breathing index rsbi in critically ill patients on mechanical ventilation
2012Co-Authors: Elaine C Goncalves, Elaine C Silva, Anibal Basile Filho, Maria Auxiliadoramartins, Edson Antonio Nicolini, Ada Clarice GastaldiAbstract:Abstract Background: The rapid Shallow Breathing index (RSBI) is the most widely used index within intensive care units as a predictor of the outcome of weaning, but differences in measurement techniques have generated doubts about its predictive value. Objective: To investigate the influence of low levels of pressure support (PS) on the RSBI value of ill patients. Method: Prospective study including 30 patients on mechanical ventilation (MV) for 72 hours or more, ready for extubation. Prior to extubation, the RSBI was measured with the patient connected to the ventilator (Drager™ Evita XL) and receiving pressure support ventilation (PSV) and 5 cmH 2 O of positive end expiratory pressure or PEEP (RSBI_MIN) and then disconnected from the VM and connected to a Wright spirometer in which respiratory rate and exhaled tidal volume were recorded for 1 min (RSBI_ESP). Patients were divided into groups according to the outcome: successful extubation group (SG) and failed extubation group (FG). Results: Of the 30 patients, 11 (37%) failed the extubation process. In the within-group comparison (RSBI_MIN versus RSBI_ESP), the values for RSBI_MIN were lower in both groups: SG (34.79±4.67 and 60.95±24.64) and FG (38.64±12.31 and 80.09±20.71; p<0.05). In the between-group comparison, there was no difference in RSBI_MIN (34.79±14.67 and 38.64±12.31), however RSBI_ESP was higher in patients with extubation failure: SG (60.95±24.64) and FG (80.09±20.71; p<0.05). Conclusion: In critically ill patients on MV for more than 72h, low levels of PS overestimate the RSBI, and the index needs to be measured with the patient Breathing spontaneously without the aid of pressure support.Keywords: ventilatory weaning; mechanical ventilation; physical therapy.Recebido: 18/10/2011 – Revisado: 08/02/2012 – Aceito: 03/04/2012
Jan O Friedrich - One of the best experts on this subject based on the ideXlab platform.
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the usefulness of the rapid Shallow Breathing index in predicting successful extubation a systematic review and meta analysis
Chest, 2021Co-Authors: Vatsal Trivedi, Dipayan Chaudhuri, Rehman Jinah, Joshua Piticaru, Arnav Agarwal, Kuan Liu, Eric Mcarthur, Michael C Sklar, Jan O FriedrichAbstract:Background Clinicians use several measures to ascertain whether individual patients will tolerate liberation from mechanical ventilation, including the rapid Shallow Breathing index (RSBI). Research Question Given varied use of different thresholds, patient populations, and measurement characteristics, how well does RSBI predict successful extubation? Study Design and Methods We searched six databases from inception through September 2019 and selected studies reporting the accuracy of RSBI in the prediction of successful extubation. We extracted study data and assessed quality independently and in duplicate. Results We included 48 studies involving RSBI measurements of 10,946 patients. Pooled sensitivity for RSBI of Interpretation As a stand-alone test, the RSBI has moderate sensitivity and poor specificity for predicting extubation success. Future research should evaluate its role as a permissive criterion to undergo a spontaneous Breathing trial (SBT) for patients who are at intermediate pretest probability of passing an SBT. Trial Registry PROSPERO; No.: CRD42020149196
Elaine C Goncalves - One of the best experts on this subject based on the ideXlab platform.
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how mechanical ventilation measurement cutoff and duration affect rapid Shallow Breathing index accuracy a randomized trial
Journal of Clinical Medicine Research, 2017Co-Authors: Elaine C Goncalves, Alessandra Fabiane Lago, Elaine C Silva, Marcelo Barros De Almeida, Anibal Basilefilho, Ada Clarice GastaldiAbstract:Background: Decreased accuracy of the rapid Shallow Breathing index (RSBI) can stem from 1) the method used to obtain this index, 2) duration of mechanical ventilation (MV), and 3) the established cutoff point. The objective was to evaluate the values of RSBI determined by three different methods, using distinct MV times and cutoff points. Methods: This prospective study included 40 subjects. Before extubation, three different methods were employed to measure RSBI: pressure support ventilator (PSV) (PSV = 5 - 8 cm H 2 O; positive end-expiratory pressure (PEEP) = 5 cm H 2 O) (RSBI_MIN), automatic tube compensation (ATC) (PSV = 0, PEEP = 5 cm H 2 O, and 100% tube compensation) (RSBI_ATC), and disconnected MV (RSBI_SP). The results were analyzed according to the MV period (less than or over 72 h) and to the outcome of extubation ( 72 h successful and failed). The accuracy of each method was determined at different cutoff points (105, 78, and 50 cycles/min/L). Results: The RSBI_MIN, RSBI_ATC, and RSBI_SP values in the group 72 h, RSBI_SP value was higher than those of RSBI_ATC and RSBI_MIN (78 ± 29, 51 ± 19 and 39 ± 14) (P 72 h who failed in removing MV, the RSBI_SP was higher (93 ± 28, 58 ± 18 and 41 ± 10) (P < 0.000), with greater accuracy at cutoff of 78. Conclusion: RSBI_SP associated with cutoff point < 78 cycles/min/L seems to be the best strategy to identify failed extubation in subjects with MV for over 72 h. J Clin Med Res. 2017;9(4):289-296 doi: https://doi.org/10.14740/jocmr2856w
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low pressure support changes the rapid Shallow Breathing index rsbi in critically ill patients on mechanical ventilation
Revista Brasileira De Fisioterapia, 2012Co-Authors: Elaine C Goncalves, Elaine C Silva, Anibal Basile Filho, Maria Auxiliadoramartins, Edson Antonio Nicolini, Ada Clarice GastaldiAbstract:BACKGROUND: The rapid Shallow Breathing index (RSBI) is the most widely used index within intensive care units as a predictor of the outcome of weaning, but differences in measurement techniques have generated doubts about its predictive value. OBJECTIVE: To investigate the influence of low levels of pressure support (PS) on the RSBI value of ill patients. METHOD: Prospective study including 30 patients on mechanical ventilation (MV) for 72 hours or more, ready for extubation. Prior to extubation, the RSBI was measured with the patient connected to the ventilator (DragerTM Evita XL) and receiving pressure support ventilation (PSV) and 5 cmH2O of positive end expiratory pressure or PEEP (RSBI_MIN) and then disconnected from the VM and connected to a Wright spirometer in which respiratory rate and exhaled tidal volume were recorded for 1 min (RSBI_ESP). Patients were divided into groups according to the outcome: successful extubation group (SG) and failed extubation group (FG). RESULTS: Of the 30 patients, 11 (37%) failed the extubation process. In the within-group comparison (RSBI_MIN versus RSBI_ESP), the values for RSBI_MIN were lower in both groups: SG (34.79±4.67 and 60.95±24.64) and FG (38.64±12.31 and 80.09±20.71; p<0.05). In the between-group comparison, there was no difference in RSBI_MIN (34.79±14.67 and 38.64±12.31), however RSBI_ESP was higher in patients with extubation failure: SG (60.95±24.64) and FG (80.09±20.71; p<0.05). CONCLUSIONS: In critically ill patients on MV for more than 72h, low levels of PS overestimate the RSBI, and the index needs to be measured with the patient Breathing spontaneously without the aid of pressure support.
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baixos niveis de pressao de suporte alteram o indice de respiracao rapida e superficial irrs em pacientes graves sob ventilacao mecânica low pressure support changes the rapid Shallow Breathing index rsbi in critically ill patients on mechanical ventilation
2012Co-Authors: Elaine C Goncalves, Elaine C Silva, Anibal Basile Filho, Maria Auxiliadoramartins, Edson Antonio Nicolini, Ada Clarice GastaldiAbstract:Abstract Background: The rapid Shallow Breathing index (RSBI) is the most widely used index within intensive care units as a predictor of the outcome of weaning, but differences in measurement techniques have generated doubts about its predictive value. Objective: To investigate the influence of low levels of pressure support (PS) on the RSBI value of ill patients. Method: Prospective study including 30 patients on mechanical ventilation (MV) for 72 hours or more, ready for extubation. Prior to extubation, the RSBI was measured with the patient connected to the ventilator (Drager™ Evita XL) and receiving pressure support ventilation (PSV) and 5 cmH 2 O of positive end expiratory pressure or PEEP (RSBI_MIN) and then disconnected from the VM and connected to a Wright spirometer in which respiratory rate and exhaled tidal volume were recorded for 1 min (RSBI_ESP). Patients were divided into groups according to the outcome: successful extubation group (SG) and failed extubation group (FG). Results: Of the 30 patients, 11 (37%) failed the extubation process. In the within-group comparison (RSBI_MIN versus RSBI_ESP), the values for RSBI_MIN were lower in both groups: SG (34.79±4.67 and 60.95±24.64) and FG (38.64±12.31 and 80.09±20.71; p<0.05). In the between-group comparison, there was no difference in RSBI_MIN (34.79±14.67 and 38.64±12.31), however RSBI_ESP was higher in patients with extubation failure: SG (60.95±24.64) and FG (80.09±20.71; p<0.05). Conclusion: In critically ill patients on MV for more than 72h, low levels of PS overestimate the RSBI, and the index needs to be measured with the patient Breathing spontaneously without the aid of pressure support.Keywords: ventilatory weaning; mechanical ventilation; physical therapy.Recebido: 18/10/2011 – Revisado: 08/02/2012 – Aceito: 03/04/2012
Ruaysheng Lai - One of the best experts on this subject based on the ideXlab platform.
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an integrative index for predicting extubation outcomes after successful completion of a spontaneous Breathing trial in an adult medical intensive care unit
Journal of Intensive Care Medicine, 2019Co-Authors: Judith Shuchu Shiao, Ruaysheng LaiAbstract:Background:Among respiratory predictors, rapid Shallow Breathing index (RSBI) has been a commonly used respiratory parameter to predict extubation outcomes. However, the outcome of prediction remai...
Thierry Boulain - One of the best experts on this subject based on the ideXlab platform.
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does diaphragm ultrasound improve the rapid Shallow Breathing index accuracy for predicting the success of weaning from mechanical ventilation
Australian Critical Care, 2021Co-Authors: Guillaume Fossat, Blanche Daillet, Emmanuelle Desmalles, Thierry BoulainAbstract:Abstract Background This prospective study investigated whether taking into account diaphragmatic excursion (DE) measured by ultrasonography would improve the performance of the rapid Shallow Breathing index (RSBI) to predict extubation success or failure. Objectives The aim of the study was to compare the new composite index named the rapid Shallow diaphragmatic index (RSDI), and the RSBI measured during a spontaneous Breathing trial regarding their ability to predict the need for re-intubation at 72 h. Methods One hundred mechanically ventilated patients underwent daily 30-min spontaneous Breathing trials (SBTs) under pressure support ventilation of 6 cm H2O and end-expiratory pressure of 0 cm H2O until the SBT was considered successful and followed by extubation. The performances of RSBI (respiratory rate/tidal volume) and of the ratio RSBI/DE measured at 5 and 25 min of the successful SBT were compared in terms of area under the receiver operating characteristics curve (AUC), for predicting extubation success at 72 h. As secondary analysis, extubation and weaning success at 7 d were also considered. As exploratory analyses, predictive indices incorporating both clinical characteristics, the DE, and ultrasound diaphragm thickening fraction (DTF) were investigated. Results RSBI and RSBI/DE showed AUCs with 95% confidence intervals consistently extending below 0.50, either at the 5th (0.55 [0.36–0.74] and 0.55 [0.34–0.75], respectively) or at the 25th minute of SBT (0.49 [0.27–0.71] and 0.50 [0.29–0.68], respectively) for predicting weaning success at 72 h or at 7 d (5th min: 0.53 [0.37–0.70] and 0.54 [0.37–0.70], respectively; 25th min: 0.54 [0.37–0.71] and 0.55 [0.39–0.71], respectively). An exploratory index incorporating the accessory respiratory muscle activity, DE, DTF, and respiratory rate at 5th min of SBT showed AUCs for predicting extubation success at 7 d in the 78 patients with DTF measurement (0.77 [0.64–0.90]) that were significantly higher than that of the RSBI (P = 0.017) and RSBI/DE (P Conclusions The RSBI and the ratio RSBI/DE failed to predict weaning success when measured during an SBT performed under minimal pressure support. Predictive indices incorporating ultrasound DE and DTF may merit further investigation.