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Rapid Shallow Breathing Index and Its Components in Predicting Extubation Outcomes
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A7212 - Rapid Shallow Breathing Index and Its Components in Predicting Extubation Outcomes
Author Block: F. Kukhon1, A. Chahin2, F. D. McCool3; 1Brown University / Memorial Hospital of Rhode Island, Pawtucket, RI, United States, 2Brown University / Memorial Hospital of Rhode Island, Providence, RI, United States, 3Brown University / Memorial Hospital of Rhode Island, Bristol, RI, United States.
RATIONALE: Different indices have been developed to predict the readiness of mechanically ventilated patients for extubation. Rapid shallow breathing index (RSBI), which is the ratio of the respiratory frequency (f) to the tidal volume (VT), is frequently used for this purpose. RSBI was validated during spontaneous breathing trials using a “T-piece”. An RSBI index > 105 breaths/min/L predicts a poor extubation outcome. The purpose of this study was to evaluate the association of RSBI and its components (VT and f) during spontaneous breathing trials using pressure support (PS) with extubation outcomes.
METHODS: This is a retrospective cohort study using the Medical Information Mart for Intensive Care (MIMIC-III) database; an initiative from Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center. We identified intensive care unit (ICU) stays during which patients were intubated for at least 48 hours but not for more than 21 days. To be considered a new event, an intubation event had to be at least eight hours apart from a previous intubation event. For each participant, VT and f were measured during a spontaneous breathing trial using the minimal level of PS needed to overcome endotracheal tube resistance. Extubation outcomes were identified as successful extubation or failed extubation (reintubation). The association between the means of VT, f, and RSBI with extubation outcomes was tested using t-test.
RESULTS: A total of 3,042 participants were included. The mean age was 61.15 ± 9.56 years, and 56.5% were males. The median ICU-length-of-stay was 7.6 days, and the median ventilation-duration was 118 hours. Of those, 2,155 (70.8%) were successfully extubated and 887 (29.2%) had failed extubation. RSBI mean was 42.8 breaths/min/L in successfully-extubated patients versus 42.1 breaths/min/L in patients with failed extubation (p = 0.633). VT measurements were also not significantly associated with extubation outcomes (569ml in successful extubation versus 581ml in failed extubation, p = 0.511). There was no significant association between f and extubation outcomes with mean f of 13.5 breaths per minute (bpm) in successfully-extubated participants, versus mean f of 14.5 bpm in failed extubation (p = 0.021).
CONCLUSION: RSBI calculated during PS breathing trials was not significantly associated with extubation outcomes. Extubation failure occurred with an RSBI index much lower than the 105 cutoff value derived from “T-piece” trials. Lower cutoffs of RSBI should be used when predicting extubation success or failure from RSBI derived during PS spontaneous breathing trials.
Author Block: F. Kukhon1, A. Chahin2, F. D. McCool3; 1Brown University / Memorial Hospital of Rhode Island, Pawtucket, RI, United States, 2Brown University / Memorial Hospital of Rhode Island, Providence, RI, United States, 3Brown University / Memorial Hospital of Rhode Island, Bristol, RI, United States.
RATIONALE: Different indices have been developed to predict the readiness of mechanically ventilated patients for extubation. Rapid shallow breathing index (RSBI), which is the ratio of the respiratory frequency (f) to the tidal volume (VT), is frequently used for this purpose. RSBI was validated during spontaneous breathing trials using a “T-piece”. An RSBI index > 105 breaths/min/L predicts a poor extubation outcome. The purpose of this study was to evaluate the association of RSBI and its components (VT and f) during spontaneous breathing trials using pressure support (PS) with extubation outcomes.
METHODS: This is a retrospective cohort study using the Medical Information Mart for Intensive Care (MIMIC-III) database; an initiative from Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center. We identified intensive care unit (ICU) stays during which patients were intubated for at least 48 hours but not for more than 21 days. To be considered a new event, an intubation event had to be at least eight hours apart from a previous intubation event. For each participant, VT and f were measured during a spontaneous breathing trial using the minimal level of PS needed to overcome endotracheal tube resistance. Extubation outcomes were identified as successful extubation or failed extubation (reintubation). The association between the means of VT, f, and RSBI with extubation outcomes was tested using t-test.
RESULTS: A total of 3,042 participants were included. The mean age was 61.15 ± 9.56 years, and 56.5% were males. The median ICU-length-of-stay was 7.6 days, and the median ventilation-duration was 118 hours. Of those, 2,155 (70.8%) were successfully extubated and 887 (29.2%) had failed extubation. RSBI mean was 42.8 breaths/min/L in successfully-extubated patients versus 42.1 breaths/min/L in patients with failed extubation (p = 0.633). VT measurements were also not significantly associated with extubation outcomes (569ml in successful extubation versus 581ml in failed extubation, p = 0.511). There was no significant association between f and extubation outcomes with mean f of 13.5 breaths per minute (bpm) in successfully-extubated participants, versus mean f of 14.5 bpm in failed extubation (p = 0.021).
CONCLUSION: RSBI calculated during PS breathing trials was not significantly associated with extubation outcomes. Extubation failure occurred with an RSBI index much lower than the 105 cutoff value derived from “T-piece” trials. Lower cutoffs of RSBI should be used when predicting extubation success or failure from RSBI derived during PS spontaneous breathing trials.
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