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

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

Research output: Contribution to journalArticle

28 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)487-495
Number of pages9
JournalIntensive Care Medicine
Volume36
Issue number3
DOIs
StatePublished - Mar 1 2010
Externally publishedYes

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Respiration
Respiratory Rate
Tidal Volume
Observational Studies

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Segal, Leopoldo N. ; Oei, Erwin ; Oppenheimer, Beno W. ; Goldring, Roberta M. ; Bustami, Rami T. ; Ruggiero, Salvatore ; Berger, Kenneth I. ; Fiel, Stanley B. / Evolution of pattern of breathing during a spontaneous breathing trial predicts successful extubation. In: Intensive Care Medicine. 2010 ; Vol. 36, No. 3. pp. 487-495.
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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.",
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Segal, LN, Oei, E, Oppenheimer, BW, Goldring, RM, Bustami, RT, Ruggiero, S, Berger, KI & Fiel, SB 2010, 'Evolution of pattern of breathing during a spontaneous breathing trial predicts successful extubation', Intensive Care Medicine, vol. 36, no. 3, pp. 487-495. https://doi.org/10.1007/s00134-009-1735-6

Evolution of pattern of breathing during a spontaneous breathing trial predicts successful extubation. / Segal, Leopoldo N.; Oei, Erwin; Oppenheimer, Beno W.; Goldring, Roberta M.; Bustami, Rami T.; Ruggiero, Salvatore; Berger, Kenneth I.; Fiel, Stanley B.

In: Intensive Care Medicine, Vol. 36, No. 3, 01.03.2010, p. 487-495.

Research output: Contribution to journalArticle

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AU - Segal, Leopoldo N.

AU - Oei, Erwin

AU - Oppenheimer, Beno W.

AU - Goldring, Roberta M.

AU - Bustami, Rami T.

AU - Ruggiero, Salvatore

AU - Berger, Kenneth I.

AU - Fiel, Stanley B.

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N2 - 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.

AB - 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.

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