- 期刊
Usefulness of Rapid Shallow Respiratory Breathing Index Measured through Mechanical Ventilator Monitoring
用呼吸器直接測量的淺快呼吸指標之應用
摘要
Background: The Rapid Shallow Breathing Index (RSBI) is widely used in weaning assessment. The threshold value of the RSBI is dependent on the patient cohort and the method used to measure it. The aims of this study were to establish a protocol for measuring the RSBI through mechanical ventilator monitoring and to simplify weaning assessment. Patients and methods: The study was conducted prospectively at Taichung Veterans General Hospital. Patients intending to discontinue mechanical ventilator use were enrolled. The RSBI was measured using 2 methods for each patient: 1) a conventional hand-held calibrated spirometry (C-RSBI), and 2) the RSBI calculated through mechanical ventilator monitoring (V-RSBI) under CPAP 5 cmH2O and a flow trigger. In addition, the ability to cough was scored semi-quantitatively. The performance of these parameters in predicting weaning failure and re-intubation within 72 hours was evaluated. Results: One hundred and eight patients (age: 66±17 years; M/F: 75/33; intubation days: 8.8±9.8) were enrolled. The C-RSBI (70±42) and V-RSBI (69±35) showed significantly good correlation (r=0.759, p＜0.001). The values of the RSBI were higher in the medical patients than in the surgical patients, but were not related to weaning failure. A poor ability to cough was a significant predictor of weaning failure. The rate of weaning failure was up to 18.2% in the patients with an ability to cough ≤3 and V-RSBI ≥60. Conclusions: The V-RSBI was measured accurately through the readout of the mechanical ventilator and its value was nearly equal to that of the C-RSBI. In combination with a non-invasive assessment of the ability to cough, V-RSBI was a simple method to assess patients with the intent to wean from the ventilator.
並列摘要
Background: The Rapid Shallow Breathing Index (RSBI) is widely used in weaning assessment. The threshold value of the RSBI is dependent on the patient cohort and the method used to measure it. The aims of this study were to establish a protocol for measuring the RSBI through mechanical ventilator monitoring and to simplify weaning assessment. Patients and methods: The study was conducted prospectively at Taichung Veterans General Hospital. Patients intending to discontinue mechanical ventilator use were enrolled. The RSBI was measured using 2 methods for each patient: 1) a conventional hand-held calibrated spirometry (C-RSBI), and 2) the RSBI calculated through mechanical ventilator monitoring (V-RSBI) under CPAP 5 cmH2O and a flow trigger. In addition, the ability to cough was scored semi-quantitatively. The performance of these parameters in predicting weaning failure and re-intubation within 72 hours was evaluated. Results: One hundred and eight patients (age: 66±17 years; M/F: 75/33; intubation days: 8.8±9.8) were enrolled. The C-RSBI (70±42) and V-RSBI (69±35) showed significantly good correlation (r=0.759, p＜0.001). The values of the RSBI were higher in the medical patients than in the surgical patients, but were not related to weaning failure. A poor ability to cough was a significant predictor of weaning failure. The rate of weaning failure was up to 18.2% in the patients with an ability to cough ≤3 and V-RSBI ≥60. Conclusions: The V-RSBI was measured accurately through the readout of the mechanical ventilator and its value was nearly equal to that of the C-RSBI. In combination with a non-invasive assessment of the ability to cough, V-RSBI was a simple method to assess patients with the intent to wean from the ventilator.