Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 3/2010

01-03-2010 | Original

Evolution of pattern of breathing during a spontaneous breathing trial predicts successful extubation

Authors: Leopoldo N. Segal, Erwin Oei, Beno W. Oppenheimer, Roberta M. Goldring, Rami T. Bustami, Salvatore Ruggiero, Kenneth I. Berger, Stanley B. Fiel

Published in: Intensive Care Medicine | Issue 3/2010

Login to get access

Abstract

Purpose

Rapid shallow breathing may occur at any time during spontaneous breathing trials (SBT), questioning the utility of a single determination of the rapid shallow breathing index (RSBI). We hypothesize that change in RSBI during SBT may more accurately predict successful extubation than a single determination.

Methods

Prospective observational study. Seventy-two subjects were extubated. At 24 h, 63/72 remained extubated (Extubation Success), and 9 were re-intubated (Extubation Failure). Respiratory rate (RR), tidal volume (VT) and RSBI were measured every 30 min during 2-h T-piece SBT. Change in respiratory parameters was assessed as percent change from baseline.

Results

Initial RSBI was similar in Extubation Success and Extubation Failure groups (77.0 ± 4.8, 77.0 ± 4.8, p = ns). Nevertheless, RSBI tended to remain unchanged or decreased in the Extubation Success group; in contrast RSBI tended to increase in the Extubation Failure group because of either increased RR and/or decreased VT (p < 0.001 for mean percent change RSBI over time), indicating worsening of the respiratory pattern. Quantitatively, only 7/63 subjects of the Extubation Success group demonstrated increased RSBI ≥20% at any time during the SBT. In contrast, in the Extubation Failure group, RSBI increased in all subjects during the SBT, and eight of nine subjects demonstrated an increase greater than 20%. Thus, with a 2-h SBT the optimal threshold was a 20% increase (sensitivity = 89%, specificity = 89%). Similar results were obtained at 30 min (threshold = 5% increase). Percent change of RSBI predicted successful extubation even when initial values were ≥105.

Conclusion

Percent change of RSBI during an SBT is a better predictor of successful extubation than a single determination of RSBI.
Literature
1.
Epstein SK, Ciubotaru RL, Wong JB (1997) Effect of failed extubation on the outcome of mechanical ventilation. Chest 112:186–192CrossRefPubMed
2.
Tobin MJ, Perez W, Guenther SM, Semmes BJ, Mador MJ, Allen SJ, Lodato RF, Dantzker DR (1986) The pattern of breathing during successful and unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis 134:1111–1118PubMed
3.
Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324:1445–1450PubMedCrossRef
4.
Berger KI, Sorkin IB, Norman RG, Rapoport DM, Goldring RM (1996) Mechanism of relief of tachypnea during pressure support ventilation. Chest 109:1320–1327CrossRefPubMed
5.
Afessa B, Hogans L, Murphy R (1999) Predicting 3-day and 7-day outcomes of weaning from mechanical ventilation. Chest 116:456–461CrossRefPubMed
6.
Lee KH, Hui KP, Chan TB, Tan WC, Lim TK (1994) Rapid shallow breathing (frequency-tidal volume ratio) did not predict extubation outcome. Chest 105:540–543CrossRefPubMed
7.
Meade M, Guyatt G, Cook D, Griffith L, Sinuff T, Kergl C, Mancebo J, Esteban A, Epstein S (2001) Predicting success in weaning from mechanical ventilation. Chest 120:400S–424SCrossRefPubMed
8.
Epstein SK (1995) Etiology of extubation failure and the predictive value of the rapid shallow breathing index. Am J Respir Crit Care Med 152:545–549PubMed
9.
Conti G, Montini L, Pennisi MA, Cavaliere F, Arcangeli A, Bocci MG, Proietti R, Antonelli M (2004) A prospective, blinded evaluation of indexes proposed to predict weaning from mechanical ventilation. Intensive Care Med 30:830–836CrossRefPubMed
10.
Tanios MA, Nevins ML, Hendra KP, Cardinal P, Allan JE, Naumova EN, Epstein SK (2006) A randomized, controlled trial of the role of weaning predictors in clinical decision making. Crit Care Med 34:2530–2535CrossRefPubMed
11.
Jubran A, Grant BJB, Laghi F, Parthasarathy S, Tobin MJ (2005) Weaning prediction: esophageal pressure monitoring complements readiness testing. Am J Respir Crit Care Med 171:1252–1259CrossRefPubMed
12.
Martinez A, Seymour C, Nam M (2003) Minute ventilation recovery time: a predictor of extubation outcome. Chest 123:1214–1221CrossRefPubMed
13.
Kuo P-H, Wu H-D, Lu B-Y, Chen M-T, Kuo S-H, Yang P-C (2006) Predictive value of rapid shallow breathing index measured at initiation and termination of a 2-hour spontaneous breathing trial for weaning outcome in ICU patients. J Formos Med Assoc 105:390–398CrossRefPubMed
14.
Chatila W, Jacob B, Guaglionone D, Manthous CA (1996) The unassisted respiratory rate-tidal volume ratio accurately predicts weaning outcome. Am J Med 101:61–67CrossRefPubMed
15.
Krieger BP, Isber J, Breitenbucher A, Throop G, Ershowsky P (1997) Serial measurements of the rapid-shallow-breathing index as a predictor of weaning outcome in elderly medical patients. Chest 112:1029–1034CrossRefPubMed
16.
Teixeira C, Zimermann Teixeira PJ, Hoher JA, de Leon PP, Brodt SF, da Siva Moreira J (2008) Serial measurements of f/VT can predict extubation failure in patients with f/VT < or = 105? J Crit Care 23:572–576CrossRefPubMed
17.
MacIntyre NR, Cook DJ, Ely EW Jr, Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn DJ (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120:375S–395SCrossRefPubMed
18.
Jubran A, Tobin MJ (1997) Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 155:906–915PubMed
19.
20.
Vassilakopoulos T, Routsi C, Sotiropoulou C, Bitsakou C, Stanopoulos I, Roussos C, Zakynthinos S (2006) The combination of the load/force balance and the frequency/tidal volume can predict weaning outcome. Intensive Care Med 32:684–691CrossRefPubMed
21.
Wysocki M, Cracco C, Teixeira A, Mercat A, Diehl J-L, Lefort Y, Derenne J-P, Similowski T (2006) Reduced breathing variability as a predictor of unsuccessful patient separation from mechanical ventilation. Crit Care Med 34:2076–2083CrossRefPubMed
22.
Engoren M (1998) Approximate entropy of respiratory rate and tidal volume during weaning from mechanical ventilation. Crit Care Med 26:1817–1823PubMed
23.
Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Mancebo J (1998) Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med 158:1855–1862PubMed
24.
Tobin MJ, Jubran A (2008) Meta-analysis under the spotlight: focused on a meta-analysis of ventilator weaning. Crit Care Med 36:1–7CrossRefPubMed
25.
Nava S, Rubini F, Zanotti E, Ambrosino N, Bruschi C, Vitacca M, Fracchia C, Rampulla C (1994) Survival and prediction of successful ventilator weaning in COPD patients requiring mechanical ventilation for more than 21 days. Eur Respir J 7:1645–1652CrossRefPubMed
26.
Alvisi R, Volta CA, Righini ER, Capuzzo M, Ragazzi R, Verri M, Candini G, Gritti G, Milic-Emili J (2000) Predictors of weaning outcome in chronic obstructive pulmonary disease patients. Eur Respir J 15:656–662CrossRefPubMed
27.
Jacob B, Chatila W, Manthous CA (1997) The unassisted respiratory rate/tidal volume ratio accurately predicts weaning outcome in postoperative patients. Crit Care Med 25:253–257CrossRefPubMed
28.
Sassoon CS, Mahutte CK (1993) Airway occlusion pressure and breathing pattern as predictors of weaning outcome. Am Rev Respir Dis 148:860–866PubMed
29.
El-Khatib MF, Jamaleddine GW, Khoury AR, Obeid MY (2002) Effect of continuous positive airway pressure on the rapid shallow breathing index in patients following cardiac surgery. Chest 121:475–479CrossRefPubMed
30.
Namen AM, Ely EW, Tatter SB, Case LD, Lucia MA, Smith A, Landry S, Wilson JA, Glazier SS, Branch CL, Kelly DL, Bowton DL, Haponik EF (2001) Predictors of successful extubation in neurosurgical patients. Am J Respir Crit Care Med 163:658–664PubMed
31.
Krieger BP, Campos M (2002) Weaning parameters: read the methodology before proceeding. Chest 122:1873–1874CrossRefPubMed
32.
33.
Rose L, Presneill JJ, Johnston L, Cade JF (2008) A randomised, controlled trial of conventional versus automated weaning from mechanical ventilation using SmartCare/PS. Intensive Care Med 34:1788–1795CrossRefPubMed
34.
Frutos-Vivar F, Ferguson ND, Esteban A, Epstein SK, Arabi Y, Apezteguia C, Gonzalez M, Hill NS, Nava S, D’Empaire G, Anzueto A (2006) Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 130:1664–1671CrossRefPubMed
35.
Epstein SK, Ciubotaru RL (1998) Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med 158:489–493PubMed
36.
Tobin MJ, Laghi F, Brochard L (2009) Role of the respiratory muscles in acute respiratory failure of COPD: lessons from weaning failure. J Appl Physiol 107:962–970CrossRefPubMed
Metadata
Title
Evolution of pattern of breathing during a spontaneous breathing trial predicts successful extubation
Authors
Leopoldo N. Segal
Erwin Oei
Beno W. Oppenheimer
Roberta M. Goldring
Rami T. Bustami
Salvatore Ruggiero
Kenneth I. Berger
Stanley B. Fiel
Publication date
01-03-2010
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 3/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1735-6

Other articles of this Issue 3/2010

Intensive Care Medicine 3/2010 Go to the issue

Correspondence

A note on statistical association and causality derived from epidemiological ICU data

Original

Angiopoietin-2 in patients requiring renal replacement therapy in the ICU: relation to acute kidney injury, multiple organ dysfunction syndrome and outcome

Original

The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness

Original

Plasma and urine neutrophil gelatinase-associated lipocalin in septic versus non-septic acute kidney injury in critical illness

Correspondence

Practice of volume therapy in patients with severe sepsis: results from a nationwide sepsis prevalence study

Correspondence

Delayed colopericardial fistula and pyopneumopericardium