Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 26 , ISSUE 9 ( September, 2022 ) > List of Articles

Original Article

Prediction of Weaning Outcome from Mechanical Ventilation Using Diaphragmatic Rapid Shallow Breathing Index

PK Shamil, NK Gupta, MK Sen, Shibdas Chakrabarti

Keywords : Critical care, Diaphragm, Ultrasonography, Ventilator weaning

Citation Information : Shamil P, Gupta N, Sen M, Chakrabarti S. Prediction of Weaning Outcome from Mechanical Ventilation Using Diaphragmatic Rapid Shallow Breathing Index. Indian J Crit Care Med 2022; 26 (9):1000-1005.

DOI: 10.5005/jp-journals-10071-24316

License: CC BY-NC 4.0

Published Online: 31-08-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Diaphragmatic dysfunction has been increasingly documented to play a critical role to determine ventilator dependency and failure of weaning. Objective: The goal was to study the diagnostic accuracy of diaphragmatic rapid shallow breathing index (D-RSBI) as a predictor of weaning outcomes in comparison to RSBI. Materials and methods: A prospective observational study on consecutively admitted patients who were intubated and mechanically ventilated for a duration of at least 48 hours was carried out. The right hemidiaphragm displacement [diaphragm displacement (DD)] was calculated by M-mode ultrasonography, and respiratory rate (RR) and tidal volume (TV) were documented from the ventilator readings. Rapid shallow breathing index (RSBI) was measured as RR/TV (in liters); D-RSBI was calculated as RR/DD (in millimeters) and expressed as breath/minute/millimeter. Extubation failure was defined as the reinstitution of mechanical ventilation at the end of, or during the spontaneous breathing trial (SBT), re-intubation or the need of noninvasive ventilation (NIV) for the patient within 48 hours of extubation. Results: Of 101 screened patients, 50 patients met the inclusion criteria, of whom 45 patients had successful SBT, and finally, 41 patients could be successfully extubated. Hence, the overall rate of weaning failure in the study population was 18%. The areas under the receiver operator characteristic (ROC) curves for D-RSBI and RSBI were 0.97 and 0.70, respectively (p <0.0001). The Pearson's correlation among RSBI and D-RSBI was 0.81 (p-value <0.001). Conclusion: Diaphragmatic rapid shallow breathing index has a positive correlation and greater diagnostic accuracy than RSBI, the conventional weaning index.

PDF Share
  1. Schmidt GA, Girard TD, Kress JP, Morris PE, Ouellette DR, Alhazzani W, et al. Liberation from mechanical ventilation in critically ill adults: Executive summary of an Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline. Chest 2017;151(1):160–165. DOI:10.1016/j.chest.2016.10.037.
  2. Ghauri SK, Javaeed A, Mustafa KJ, Khan AS. Predictors of prolonged mechanical ventilation in patients admitted to intensive care units: A systematic review. Int J Health Sci (Qassim) 2019;13(6):31–38. PMCID: PMC6852505.
  3. Doorduin J, van Hees HW, van der Hoeven JG, Heunks LM. Monitoring of the respiratory muscles in the critically ill. Am J Respir Crit Care Med 2013;187(1):20–27. DOI: 10.1164/rccm.201206-1117CP.
  4. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by M-mode ultrasonography. Chest 2009;135(2):391–400. DOI: 10.1378/chest.08-1541.
  5. Kim WY, Suh HJ, Hong SB, Koh Y, Lim CM. Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation. Crit Care Med 2011;39(12):2627–2630. DOI: 10.1097/CCM.0b013e3182266408.
  6. Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients. Aust Crit Care 2017;30(1):37–43. DOI: 10.1016/j.aucc.2016.03.004.
  7. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991;324(21):1445–1450. DOI: 10.1056/NEJM199105233242101.
  8. Lee KH, Hui KP, Chan TB, Tan WC, Lim TK. Rapid shallow breathing (frequency tidal volume ratio) did not predict extubation outcome. Chest 1994;105(2):540–543. DOI: 10.1378/chest.105.2.540.
  9. Savi A, Teixeira C, Silva JM, Borges LG, Pereira PA, Pinto KB, et al. Weaning predictors do not predict extubation failure in simple- to-wean patients. J Crit Care 2012;27(2):221.e1–221.e8. DOI: 10.1016/j.jcrc.2011.07.079.
  10. Shin HJ, Chang JS, Ahn S, Kim TO, Park CK, Lim JH, et al. Clinical factors associated with weaning failure in patients requiring prolonged mechanical ventilation. J Thorac Dis 2017;9(1):143–150. DOI: 10.21037/jtd.2017.01.14.
  11. Dehghani A, Davaridolatabadi E, Abdeyazdan G. Comparison of SOFA and APACHE II scores in predicting weaning of patients from ventilator in the ICU ward of Amin Hospital in Isfahan, Iran. J Med Res Health Sci 2016, 5(9S):128–136.
  12. Rojek-Jarmuła A, Hombach R, Krzych ŁJ. APACHE II score cannot predict successful weaning from prolonged mechanical ventilation. Chron Respir Dis 2017;14(3):270–275. DOI: 10.1177/1479972316687100.
  13. Mowafy SMS, Abdelgalel EF. Diaphragmatic rapid shallow breathing index for predicting weaning outcome from mechanical ventilation: comparison with traditional rapid shallow breathing index. Egyptian J Anaesth 2018;35(1):9–17. DOI: 10.1016/j.egja.2018.10.003.
  14. Muzaffar SN, Gurjar M, Baronia AK, et al. Predictors and pattern of weaning and long-term outcome of patients with prolonged mechanical ventilation at an acute intensive care unit in North India. Rev Bras Ter Intensiva 2017;29(1):23–33. DOI: 10.5935/0103-507X.20170005.
  15. Bien U dos S, Souza GF, Campos ES, et al. Maximum inspiratory pressure and rapid shallow breathing index as predictors of successful ventilator weaning. J Phys Ther Sci 2015;27(12):3723–3727. DOI: 10.1589/jpts.27.3723.
  16. Karthika M, Al Enezi FA, Pillai LV, Arabi YM. Rapid shallow breathing index. Ann Thorac Med 2016;11(3):167–176. DOI:10.4103/1817-1737.176876.
  17. Danaga AR, Gut AL, Antunes LC, Ferreira AL, Yamaguti FA, Christovan JC, et al. Evaluation of the diagnostic performance and cut-off value for the rapid shallow breathing index in predicting extubation failure. J Bras Pneumol 2009;35(6):541–547. DOI: 10.1590/s1806-37132009000600007.
  18. Vallverdu I, Calaf N, Subirana M, Net A, Benito S, Mancebo J. 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 1998;158(6):1855–1862. DOI: 10.1164/ajrccm.158.6.9712135.
  19. Yan S, Lichros I, Zakynthinos S, Macklem PT. Effect of diaphragmatic fatigue on control of respiratory muscles and ventilation during CO2 rebreathing. J Appl Physiol 1993;75(3):1364–1370. DOI: 10.1152/jappl.1993.75.3.1364.
  20. Llamas-Álvarez AM, Tenza-Lozano EM, Latour-Pérez J. Diaphragm and lung ultrasound to predict weaning outcome: Systematic review and meta-analysis. Chest 2017;152(6):1140–1150. DOI:10.1016/j.chest.2017.08.028.
  21. Pirompanich P, Romsaiyut S. Correction to: Use of diaphragm thickening fraction combined with rapid shallow breathing index for predicting success of weaning from mechanical ventilator in medical patients. J Intensive Care 2018;6:25. DOI:10.1186/s40560-018-0293-9.
  22. Vivier E, Muller M, Putegnat JB, Steyer J, Barrau S, Boissier F, et al. Inability of diaphragm ultrasound to predict extubation failure: A multicenter study. Chest 2019;155(6):1131–1139. DOI:10.1016/j.chest.2019.03.004.
  23. Spadaro S, Grasso S, Mauri T, Corte FD, Alvisi V, Ragazzi R, et al. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Crit Care 2016;20(1):305. DOI: 10.1186/s13054- 016-1479-y.
  24. Banerjee A, Mehrotra G. Comparison of lung ultrasound-based weaning indices with rapid shallow breathing index: Are they helpful? Indian J Crit Care Med 2018;22(6):435–440. DOI: 10.4103/ijccm.IJCCM_331_17.
  25. El-Baradey GF, El-Shmaa NS, Ganna SA. Can integrative weaning index be a routine predictor for weaning success? Indian J Crit Care Med 2015;19(12):703–707. DOI: 10.4103/0972-5229.171352.
  26. Ray A. Integrative weaning index: A few observations. Indian J Crit Care Med 2017;21(11):805–806. DOI: 10.4103/0972-5229.218154.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.