A clinical study about D -RSBI directed weaning in the ICU patients undergoing mechanical ventilation

Feng Hui; Chen Bing; Tian Jing; Liu Yi

doi:10.3969/j.issn.1002-1949.2019.01.007

Abstract：Objective To compare the ability of the traditional rapid shallow breathing index (RSBI) and diaphragmatic-RSBI (D-RSBI) to predict weaning failure in ready-to-wean patients. Methods We performed a prospective observational study. The patients undergoing mechanical ventilation admitted to Department of Critical Care Medicine of the Second Hospital of Tianjin Medical University from June 2017 to March 2018 were enrolled. All patients underwent spontaneous breathing test ( SBT ), and rapid shallow breathing index ( RSBI ) was recorded. The indicators of right diaphragmatic displacement (DD) were determined by M-mode ultrasonography at the end of SBT, and D-RSBI (RR/DD) was calculated. The patients were divided into successful weaning group andfailure weaning group, and the differences in above indexes were compared between the two groups. Receiver operating characteristic(ROC) curve was used to evaluate the predictive value of RSBI and D-RSBI at 60 minutes of SBT. Results A total of 31 patients were enrolled in the study. Most of the patients, 25 (81% ), were successfully weaned from mechanical ventilation, 6 patients failed (19% ). The area under the ROC curves for D-RSBI was 0. 87. A cut of D-RSBI >1. 8 breaths/( min·mm) yielded 66. 7% sensitivity, 96. 2% specificity, 88. 3% PPV and 87. 1% NPV. On the other hand, the area under the ROC curves for RSBI was 0. 80 (P<0. 05). A cut of RSBI>92. 3 breaths/(min·L) yielded 100% sensitivity, 68% specificity, 57. 2% PPV and 100% NPV. Conclusion A lot of indexes can be used to predict outcome of weaning from mechanical ventilation. D-RSBI (RR/DD) was more accurate than traditional RSBI (RR/VT) in predicting the weaning outcome.