A rapid shallow breathing index threshold of 85 best predicts extubation success in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure

Reza Goharani, Amir Vahedian-Azimi, Iman H Galal, Leonardo Cordeiro de Souza, Behrooz Farzanegan, Farshid R Bashar, Michele Vitacca, Seyedpouzhia Shojaei, Seyed M M Mosavinasab, Shunsuke Takaki, Andrew C Miller

Research output: Contribution to journalArticle

Abstract

Background: The rapid shallow breathing index (RSBI) is used clinically to help predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the traditional threshold (<105 breaths/min/L) may underperform in patients with chronic obstructive pulmonary disease (COPD). We sought to determine the optimal RSBI threshold for COPD patients to improve the diagnostic accuracy for predicting successful ventilator liberation.

Methods: This was a prospective observational multicenter study of COPD patients [according to Global initiative for Chronic Obstructive Lung Disease (GOLD) criteria] admitted to the Medical ICUs of eight academic medical centers. All patients were intubated for hypercapnic respiratory failure and met the American Thoracic Society/European Respiratory Society guidelines to participate in a weaning trial. Ventilator weaning was conducted according to a defined protocol. RSBI was measured through the ventilator after 120 minutes of spontaneous breathing trial (SBT).

Results: Ninety patients were included (39 males and 51 females). Forty-three patients (48%) were successfully extubated whereas 47 patients (52%) failed extubation. Significant differences were observed between groups for duration-of-intubation [duration of intubation (DoI); P<0.0001], spontaneous tidal volume (VT) (P=0.03), and the ratio of dynamic-to-static compliance (P=0.005). The RSBI threshold of ≤85 breaths/min/L performed best: area under curve (AUC) receiver operating characteristic (ROC) curves 0.91, sensitivity 95.6%, specificity 90.4%, positive predictive value (PPV) 95.5%, and negative predictive value (NPV) 90.6%., positive likelihood ratio (LR+) 5.48, negative likelihood ratio (LR-) 0.25, and the diagnostic accuracy 91.7%. In post-ROC analyses, DoI and hospital length-of-stay (LOS) did not impact performance.

Conclusions: In COPD patients intubated with hypercapnia, RSBI ≤85 breaths/min/L outperformed the widely used threshold <105 breaths/min/L, yielding a 95.5% probability of extubation success, independent of ventilation duration or hospital LOS.

Original languageEnglish
Pages (from-to)1223-1232
Number of pages10
JournalJournal of Thoracic Disease
Volume11
Issue number4
DOIs
Publication statusPublished - Apr 2019

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Respiratory Insufficiency
Chronic Obstructive Pulmonary Disease
Respiration
Length of Stay
Intubation
Mechanical Ventilators
ROC Curve
Ventilator Weaning
Hypercapnia
Tidal Volume
Weaning
Artificial Respiration
Compliance
Multicenter Studies
Area Under Curve
Observational Studies
Ventilation
Guidelines
Sensitivity and Specificity

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A rapid shallow breathing index threshold of 85 best predicts extubation success in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure. / Goharani, Reza; Vahedian-Azimi, Amir; Galal, Iman H; Cordeiro de Souza, Leonardo; Farzanegan, Behrooz; Bashar, Farshid R; Vitacca, Michele; Shojaei, Seyedpouzhia; Mosavinasab, Seyed M M; Takaki, Shunsuke; Miller, Andrew C.

In: Journal of Thoracic Disease, Vol. 11, No. 4, 04.2019, p. 1223-1232.

Research output: Contribution to journalArticle

Goharani, R, Vahedian-Azimi, A, Galal, IH, Cordeiro de Souza, L, Farzanegan, B, Bashar, FR, Vitacca, M, Shojaei, S, Mosavinasab, SMM, Takaki, S & Miller, AC 2019, 'A rapid shallow breathing index threshold of 85 best predicts extubation success in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure', Journal of Thoracic Disease, vol. 11, no. 4, pp. 1223-1232. https://doi.org/10.21037/jtd.2019.03.103
Goharani, Reza ; Vahedian-Azimi, Amir ; Galal, Iman H ; Cordeiro de Souza, Leonardo ; Farzanegan, Behrooz ; Bashar, Farshid R ; Vitacca, Michele ; Shojaei, Seyedpouzhia ; Mosavinasab, Seyed M M ; Takaki, Shunsuke ; Miller, Andrew C. / A rapid shallow breathing index threshold of 85 best predicts extubation success in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure. In: Journal of Thoracic Disease. 2019 ; Vol. 11, No. 4. pp. 1223-1232.
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abstract = "Background: The rapid shallow breathing index (RSBI) is used clinically to help predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the traditional threshold (<105 breaths/min/L) may underperform in patients with chronic obstructive pulmonary disease (COPD). We sought to determine the optimal RSBI threshold for COPD patients to improve the diagnostic accuracy for predicting successful ventilator liberation.Methods: This was a prospective observational multicenter study of COPD patients [according to Global initiative for Chronic Obstructive Lung Disease (GOLD) criteria] admitted to the Medical ICUs of eight academic medical centers. All patients were intubated for hypercapnic respiratory failure and met the American Thoracic Society/European Respiratory Society guidelines to participate in a weaning trial. Ventilator weaning was conducted according to a defined protocol. RSBI was measured through the ventilator after 120 minutes of spontaneous breathing trial (SBT).Results: Ninety patients were included (39 males and 51 females). Forty-three patients (48{\%}) were successfully extubated whereas 47 patients (52{\%}) failed extubation. Significant differences were observed between groups for duration-of-intubation [duration of intubation (DoI); P<0.0001], spontaneous tidal volume (VT) (P=0.03), and the ratio of dynamic-to-static compliance (P=0.005). The RSBI threshold of ≤85 breaths/min/L performed best: area under curve (AUC) receiver operating characteristic (ROC) curves 0.91, sensitivity 95.6{\%}, specificity 90.4{\%}, positive predictive value (PPV) 95.5{\%}, and negative predictive value (NPV) 90.6{\%}., positive likelihood ratio (LR+) 5.48, negative likelihood ratio (LR-) 0.25, and the diagnostic accuracy 91.7{\%}. In post-ROC analyses, DoI and hospital length-of-stay (LOS) did not impact performance.Conclusions: In COPD patients intubated with hypercapnia, RSBI ≤85 breaths/min/L outperformed the widely used threshold <105 breaths/min/L, yielding a 95.5{\%} probability of extubation success, independent of ventilation duration or hospital LOS.",
author = "Reza Goharani and Amir Vahedian-Azimi and Galal, {Iman H} and {Cordeiro de Souza}, Leonardo and Behrooz Farzanegan and Bashar, {Farshid R} and Michele Vitacca and Seyedpouzhia Shojaei and Mosavinasab, {Seyed M M} and Shunsuke Takaki and Miller, {Andrew C}",
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T1 - A rapid shallow breathing index threshold of 85 best predicts extubation success in chronic obstructive pulmonary disease patients with hypercapnic respiratory failure

AU - Goharani, Reza

AU - Vahedian-Azimi, Amir

AU - Galal, Iman H

AU - Cordeiro de Souza, Leonardo

AU - Farzanegan, Behrooz

AU - Bashar, Farshid R

AU - Vitacca, Michele

AU - Shojaei, Seyedpouzhia

AU - Mosavinasab, Seyed M M

AU - Takaki, Shunsuke

AU - Miller, Andrew C

PY - 2019/4

Y1 - 2019/4

N2 - Background: The rapid shallow breathing index (RSBI) is used clinically to help predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the traditional threshold (<105 breaths/min/L) may underperform in patients with chronic obstructive pulmonary disease (COPD). We sought to determine the optimal RSBI threshold for COPD patients to improve the diagnostic accuracy for predicting successful ventilator liberation.Methods: This was a prospective observational multicenter study of COPD patients [according to Global initiative for Chronic Obstructive Lung Disease (GOLD) criteria] admitted to the Medical ICUs of eight academic medical centers. All patients were intubated for hypercapnic respiratory failure and met the American Thoracic Society/European Respiratory Society guidelines to participate in a weaning trial. Ventilator weaning was conducted according to a defined protocol. RSBI was measured through the ventilator after 120 minutes of spontaneous breathing trial (SBT).Results: Ninety patients were included (39 males and 51 females). Forty-three patients (48%) were successfully extubated whereas 47 patients (52%) failed extubation. Significant differences were observed between groups for duration-of-intubation [duration of intubation (DoI); P<0.0001], spontaneous tidal volume (VT) (P=0.03), and the ratio of dynamic-to-static compliance (P=0.005). The RSBI threshold of ≤85 breaths/min/L performed best: area under curve (AUC) receiver operating characteristic (ROC) curves 0.91, sensitivity 95.6%, specificity 90.4%, positive predictive value (PPV) 95.5%, and negative predictive value (NPV) 90.6%., positive likelihood ratio (LR+) 5.48, negative likelihood ratio (LR-) 0.25, and the diagnostic accuracy 91.7%. In post-ROC analyses, DoI and hospital length-of-stay (LOS) did not impact performance.Conclusions: In COPD patients intubated with hypercapnia, RSBI ≤85 breaths/min/L outperformed the widely used threshold <105 breaths/min/L, yielding a 95.5% probability of extubation success, independent of ventilation duration or hospital LOS.

AB - Background: The rapid shallow breathing index (RSBI) is used clinically to help predict a patient's likelihood of successful liberation from mechanical ventilation (MV). However, the traditional threshold (<105 breaths/min/L) may underperform in patients with chronic obstructive pulmonary disease (COPD). We sought to determine the optimal RSBI threshold for COPD patients to improve the diagnostic accuracy for predicting successful ventilator liberation.Methods: This was a prospective observational multicenter study of COPD patients [according to Global initiative for Chronic Obstructive Lung Disease (GOLD) criteria] admitted to the Medical ICUs of eight academic medical centers. All patients were intubated for hypercapnic respiratory failure and met the American Thoracic Society/European Respiratory Society guidelines to participate in a weaning trial. Ventilator weaning was conducted according to a defined protocol. RSBI was measured through the ventilator after 120 minutes of spontaneous breathing trial (SBT).Results: Ninety patients were included (39 males and 51 females). Forty-three patients (48%) were successfully extubated whereas 47 patients (52%) failed extubation. Significant differences were observed between groups for duration-of-intubation [duration of intubation (DoI); P<0.0001], spontaneous tidal volume (VT) (P=0.03), and the ratio of dynamic-to-static compliance (P=0.005). The RSBI threshold of ≤85 breaths/min/L performed best: area under curve (AUC) receiver operating characteristic (ROC) curves 0.91, sensitivity 95.6%, specificity 90.4%, positive predictive value (PPV) 95.5%, and negative predictive value (NPV) 90.6%., positive likelihood ratio (LR+) 5.48, negative likelihood ratio (LR-) 0.25, and the diagnostic accuracy 91.7%. In post-ROC analyses, DoI and hospital length-of-stay (LOS) did not impact performance.Conclusions: In COPD patients intubated with hypercapnia, RSBI ≤85 breaths/min/L outperformed the widely used threshold <105 breaths/min/L, yielding a 95.5% probability of extubation success, independent of ventilation duration or hospital LOS.

U2 - 10.21037/jtd.2019.03.103

DO - 10.21037/jtd.2019.03.103

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SP - 1223

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JO - Journal of Thoracic Disease

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