The Role of Rapid Shallow Breathing Index in Predicting Successful Weaning of Pediatric Patients with Respiratory Failure

Authors

1 Fellowship of Pediatric Pulmonology, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Pediatric Pulmonologist, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Background
About 40 to 60% of all patients admitted to pediatric intensive care unitsundergo mechanical ventilation and 10 to 20% will fail to be extubated. We aimed to determine the role of the rapid shallow breathing index (RSBI) in predicting successful weaning of pediatric patients with respiratory failure.  
Materials and Methods: This cross-sectional study, was performed on 72 mechanically ventilated children (36 in the lung failure group and 36 in the pump failure group) who were admitted in Tabriz children’s hospital in pediatric intensive care unit (PICU), Tabriz city, Iran. In order to spontaneous breathing trial (SBT) criteria, the patients who had FiO2 less than 40%, PEEP less than or equal to 5 cmH2O and PaO2 higher than 60 mmHg, was placed on spontaneous ventilation mode (PSV+CPAP) to maintain a PEEP of less than or equal to 5 cmH2O, PS of less than or equal to 8 cmH2O and FiO2 of less than or equal to 40%. After 2 hours, measured tidal volume and respiratory rate to calculate the RSBI then the patient was extubated.
Results: From 72 patients were enrolled in this study, 26 patients failed in extubation. The total RSBI threshold was 6.7 breath/min/ml/kg (AUC = 0.739, 95%CI = 0.618 – 0.861; p = 0.001)) with a sensitivity of 73.1% and a specificity of 80.4% for success of extubation. Patients successfully extubated had significantly lower RSBI 4.65 ± 3.03 breath/min/ml/kg compared to extubation failuregroup.
Conclusion
Based on the result of this study, the rapid shallow breathing index with a threshold of 6.7 breath/min/ml/kg was considered to be an acceptable and practical criterion for predicting the outcome of weaning in children.

Keywords