Predictive value of diaphragm rapid shallow breathing index in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

DOU Zhimin , LI Hong , ZHU Lei , CHEN Qiming ,  LI Bin ,  LIU Jian

Department of Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, P. R. China;

Corresponding author：

LI Bin, Email: lynd0001@163.com

Keywords：

Chronic obstructive pulmonary disease; Rapid shallow breathing index; Mechanical ventilation; Weaning

DOI：

10.7507/1671-6205.201712001

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ObjectiveTo investigate the predictive value of diaphragm rapid shallow breathing index (D-RBSI) in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD).MethodsSeventy-six patients with COPD who were undergoing mechanical ventilation were enrolled in department of critical care medicine of our hospital from March 2016 to March 2017. The patient underwent spontaneous breathing test (SBT) using CPAP mode after weaning screening. When the SBT had started 10 min or the SBT failed, the patients' respiratory rate (RR) and tidal volume were recorded, and the diaphragmatic displacement (DD) of patients was measured by bedside ultrasound. The ratio of RR to DD (RR/DD) was calculated as D-RBSI, and the predictive value of D-RBSI on weaning results in mechanically ventilated patients with COPD was analyzed by receiver operating characteristic (ROC) curve.ResultsTwenty-eight patients failed weaning procedure. There were no significant differences in age and acute physiology and chronic health evaluation II scores between the successful group and the failed group. The DD of the patients in the successful group was greater than that of the failed group [(22±6) mm vs. (13±5) mm, P<0.001]. RBSI and D-RBSI of the successful group were lower than those of the failure group [RBSI: (40±14) breaths/(min·L)vs. (52±20) breaths/(min·L), P=0.003; D-RBSI: (0.95±0.51) breaths/(min·mm) vs. (1.79±0.83) breaths/(min·mm), P<0.001)]. There was a good correlation between the RBSI and D-RBSI in the two groups (R²=0.778, P<0.001). The area under the ROC curve predicted the weaning result by D-RBSI was higher than RBSI (0.85vs. 0.75, P<0 001="" the="" cutoff="" value="" of="" d-rbsi="">1.13 breaths/(min·mm) to predict weaning failure had a sensitivity of 0.82, and a specificity of 0.81.ConclusionThe rapid shallow breathing index of diaphragm can be effectively used to predict the weaning result of COPD patients during mechanical ventilation.

Citation： DOU Zhimin, LI Hong, ZHU Lei, CHEN Qiming, LI Bin, LIU Jian. Predictive value of diaphragm rapid shallow breathing index in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(2): 124-127. doi: 10.7507/1671-6205.201712001 Copy

1.	Burns KEA, Soliman I, Adhikari NKJ, et al. Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis. Crit Care, 2017, 21(1): 127.
2.	Girard TD, Alhazzani W, Kress JP, et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med, 2017, 195(1): 120-133.
3.	Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med, 2011, 39(12): 2612-2618.
4.	Karthika M, Al Enezi FA, Pillai LV, et al. Rapid shallow breathing index. Ann Thorac Med, 2016, 11(3): 167-176.
5.	Lee KH, Hui KP, Chan TB, et al. Rapid shallow breathing (frequency- tidal volume ratio) did not predict extubation outcome. Chest, 1994, 105: 540-543.
6.	Huang CT, Yu CJ. Conventional weaning parameters do not predict extubation outcome in intubated subjects requiring prolonged mechanical ventilation. Respir Care, 2013, 58: 1307-1314.
7.	Savi A, Teixeira C, Silva JM, et al. Weaning predictors do not predict extubation failure in simple-to-wean patients. J Crit Care, 2012, 27(2): 221.
8.	Schellekens WJ, van Hees HW, Doorduin J, et al. Strategies to optimize respiratory muscle function in ICU patients. Crit Care, 2016, 20(1): 103.
9.	Capdevila X, Perrigault PF, Ramonatxo M, Roustan JP, Peray P, d’Athis F, Prefaut C. Changes in breathing pattern and respiratory muscle performance parameters during difficult weaning. Crit Care Med, 1998, 26(1): 79-87.
10.	Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure—a structured approach. Crit Care. 2010;14(6): 245.
11.	Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med, 2017, 195(5): 557-582.
12.	Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J, 2007, 29(5): 1033-1056.
13.	Francis CA, Hoffer JA, Reynolds S. Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients. Am J Crit Care, 2016, 25(1): e1-8.
14.	李敏, 黄绍光, 汤葳, 等. 呼吸功作为慢性阻塞性肺病患者撤机指标的评价. 中华急诊医学杂志, 2003, 12(12): 836-838.
15.	Tobin MJ, Laghi F, Brochard L. Role of the respiratory muscles in acute respiratory failure of COPD: lessons from weaning failure. J Appl Physiol (1985), 2009, 107(3): 962-970.
16.	丁立君, 阎锡新, 宋贝贝, 等. 慢性阻塞性肺疾病模型大鼠膈肌功能的实验研究. 国际呼吸杂志, 2009, 29(15): 905-908.
17.	陈重泽, 连细华, 杨如容, 等. 超声研究膈肌移动度与对合角度对 COPD 病情初步判定. 中国超声医学杂志, 2016, 32(1): 34-36.
18.	Lerolle N, Diehl JL. Ultrasonographic evaluation of diaphragmatic function. Crit Care Med, 2011, 39(12): 2760-2761.
19.	DiNino E, Gartman EJ, Sethi JM, et al. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax, 2014, 69(5): 423-427.（这个对）.
20.	Jiang JR, Tsai TH, Jerng JS, et al. Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest, 2004, 126(1): 179-185.
21.	DiNino E, Gartman E J, Sethi J M, et al. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax, 2013, 69(5): 431-435.
22.	Ferrari G, De Filippi G, Elia F, et al. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J, 2014, 6(1): 8.
23.	Chao DC, Scheinhorn DJ. Determining the best threshold of rapid shallow breathing index in a therapist-implemented patient-specific weaning protocol. Respir Care, 2007, 52(2): 159-165.
24.	Smargiassi A, Inchingolo R, Tagliaboschi L, et al. Ultrasonographic assessment of the diaphragm in chronic obstructive pulmonary disease patients: relationships with pulmonary function and the influence of body composition - a pilot study. Respiration, 2014, 87(5): 364-371.

1. Burns KEA, Soliman I, Adhikari NKJ, et al. Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis. Crit Care, 2017, 21(1): 127.
2. Girard TD, Alhazzani W, Kress JP, et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med, 2017, 195(1): 120-133.
3. Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med, 2011, 39(12): 2612-2618.
4. Karthika M, Al Enezi FA, Pillai LV, et al. Rapid shallow breathing index. Ann Thorac Med, 2016, 11(3): 167-176.
5. Lee KH, Hui KP, Chan TB, et al. Rapid shallow breathing (frequency- tidal volume ratio) did not predict extubation outcome. Chest, 1994, 105: 540-543.
6. Huang CT, Yu CJ. Conventional weaning parameters do not predict extubation outcome in intubated subjects requiring prolonged mechanical ventilation. Respir Care, 2013, 58: 1307-1314.
7. Savi A, Teixeira C, Silva JM, et al. Weaning predictors do not predict extubation failure in simple-to-wean patients. J Crit Care, 2012, 27(2): 221.
8. Schellekens WJ, van Hees HW, Doorduin J, et al. Strategies to optimize respiratory muscle function in ICU patients. Crit Care, 2016, 20(1): 103.
9. Capdevila X, Perrigault PF, Ramonatxo M, Roustan JP, Peray P, d’Athis F, Prefaut C. Changes in breathing pattern and respiratory muscle performance parameters during difficult weaning. Crit Care Med, 1998, 26(1): 79-87.
10. Heunks LM, van der Hoeven JG. Clinical review: the ABC of weaning failure—a structured approach. Crit Care. 2010;14(6): 245.
11. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med, 2017, 195(5): 557-582.
12. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J, 2007, 29(5): 1033-1056.
13. Francis CA, Hoffer JA, Reynolds S. Ultrasonographic Evaluation of Diaphragm Thickness During Mechanical Ventilation in Intensive Care Patients. Am J Crit Care, 2016, 25(1): e1-8.
14. 李敏, 黄绍光, 汤葳, 等. 呼吸功作为慢性阻塞性肺病患者撤机指标的评价. 中华急诊医学杂志, 2003, 12(12): 836-838.
15. Tobin MJ, Laghi F, Brochard L. Role of the respiratory muscles in acute respiratory failure of COPD: lessons from weaning failure. J Appl Physiol (1985), 2009, 107(3): 962-970.
16. 丁立君, 阎锡新, 宋贝贝, 等. 慢性阻塞性肺疾病模型大鼠膈肌功能的实验研究. 国际呼吸杂志, 2009, 29(15): 905-908.
17. 陈重泽, 连细华, 杨如容, 等. 超声研究膈肌移动度与对合角度对 COPD 病情初步判定. 中国超声医学杂志, 2016, 32(1): 34-36.
18. Lerolle N, Diehl JL. Ultrasonographic evaluation of diaphragmatic function. Crit Care Med, 2011, 39(12): 2760-2761.
19. DiNino E, Gartman EJ, Sethi JM, et al. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax, 2014, 69(5): 423-427.（这个对）.
20. Jiang JR, Tsai TH, Jerng JS, et al. Ultrasonographic evaluation of liver/spleen movements and extubation outcome. Chest, 2004, 126(1): 179-185.
21. DiNino E, Gartman E J, Sethi J M, et al. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax, 2013, 69(5): 431-435.
22. Ferrari G, De Filippi G, Elia F, et al. Diaphragm ultrasound as a new index of discontinuation from mechanical ventilation. Crit Ultrasound J, 2014, 6(1): 8.
23. Chao DC, Scheinhorn DJ. Determining the best threshold of rapid shallow breathing index in a therapist-implemented patient-specific weaning protocol. Respir Care, 2007, 52(2): 159-165.
24. Smargiassi A, Inchingolo R, Tagliaboschi L, et al. Ultrasonographic assessment of the diaphragm in chronic obstructive pulmonary disease patients: relationships with pulmonary function and the influence of body composition - a pilot study. Respiration, 2014, 87(5): 364-371.

Chinese Journal of Respiratory and Critical Care Medicine

Predictive value of diaphragm rapid shallow breathing index in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease

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