China
Africa
Explore chapters and articles related to this topic
Diaphragm Ultrasound during Weaning from Mechanical Ventilation
Published in Massimo Zambon, Ultrasound of the Diaphragm and the Respiratory Muscles, 2022
Mark E. Haaksma, Heder J. de Vries, Leo Heunks, Pieter R. Tuinman
Recently, a study evaluated the incorporation of diaphragm excursion to the well-known rapid shallow breathing index (32). While the study showed promising results, this approach still needs to be validated in larger trials.
Weaning from Mechanical Ventilation
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
There are no objective indices that have proven to be accurate in predicting when the patient is ready to begin weaning or when removal of the endotracheal tube is appropriate. For the former, the rapid shallow breathing index (respiratory rate/spontaneous tidal volume) does correlate with a patient's ability to sustain breathing and has been used inconsistently with a cutoff value of 100 [4]. For the latter, the cuff-leak test has been proposed as a mechanism of predicting extubation failure. Unfortunately, the cuff-leak test is limited by inconsistent standards for its interpretation. In addition, its pooled sensitivity of 0.66 and specificity of 0.88 for reintubation make it problematic for making individual patient decisions [5].
Clinical Workflows Supported by Patient Care Device Data
Published in John R. Zaleski, Clinical Surveillance, 2020
One measure that has been used as a simple determinant of the successful ability to wean from mechanical ventilation is the rapid-shallow breathing index (RSBI) developed originally by Yang and Tobin [113]. The RSBI ratio of respiratory rate to tidal volume is defined in Equation 5.11. The ratio of respiration rate to tidal volume during spontaneous breathing trials as a scalar assessment of likelihood that a patient could be successfully extubated. Yang and Tobin had determined in their original research findings that a patient who experienced a ratio below 105 during the period of spontaneous breathing trials was less likely to be successfully extubated than a candi-date with a ratio value above 105.
Parkinson’s disease dystonia as a cause of respiratory distress and stridor
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Mohammed A.M. Farooqi, Ahmed Attar, Arun Mensinkai, Gerard Cox
On further history, it was found that this patient had poorly controlled Parkinson’s disease, diagnosed eight years ago, with significant tremors, dyskinesias and dystonia. She reported compliance with levodopa-carbidopa 100/25 mg QID, amantadine 100 mg BID and pramipexole 0.25 mg daily. She had been on levodopa therapy for the past 7 years. Other past medical history included prior stage 3 A breast cancer, treated with chemotherapy, radiation, local resection and hormonal therapy; and GERD, for which she was on a proton-pump inhibitors (PPI). Shortly after transfer to the ICU, she was requiring minimal ventilatory support and was quickly transitioned from pressure control ventilation with a peak inspiratory pressure (PIP) of 15 and positive end-expiratory pressure (PEEP) of 5, FiO2 0.35, to pressure support ventilation with a PIP of 12 and PEEP of 10 on the same night. When assessed next morning, she had a rapid shallow breathing index (RSBI) of 44 and was promptly extubated without complication. She was no longer dyspneic post-extubation. She was discharged home the next day with a provisional diagnosis of an asthma exacerbation and was asked to continue inhalers and a short course of prednisone.
Diaphragmatic ultrasound in weaning ventilated patients: a reliable predictor?
Published in Expert Review of Respiratory Medicine, 2022
Khalil El Gharib, Marc Assaad, Michel Chalhoub
Successful liberation from MV is dependent on several factors, mainly adequate oxygenation, stable hemodynamics needing no or low-dose vasopressors, and intact neurologic status allowing complete clearance of airway secretions. Patients traditionally undergo spontaneous breathing trial (SBT); once judged to have passed the aforementioned criteria and exhibit a rapid shallow breathing index (RSBI) of less than 105 breaths/min/L, they are extubated [2]. However, more than 20% of these patients are re-intubated either due to unexpected cardiopulmonary destabilization, stagnating secretions, or even diaphragmatic dysfunction, as accessory muscles become more fatigued, unmasking the latter, despite an initially comforting RSBI [3].
Resting pulmonary function and artery pressure and cardiopulmonary exercise testing in chronic heart failure patients in Taiwan − a prospective observational cross-sectional study comparing healthy subjects and interstitial lung disease patients
Published in Annals of Medicine, 2023
Ming-Lung Chuang, Sung-Kien Sia, Kai-Wei Chang
Similarly, the Bf in patients with CHF is different from that typically associated with restrictive ventilation limitation at peak exercise (i.e. ≥50 breaths/min) [2,4,10,15,16]. Moreover, breathing-related time variables such as inspiratory time (TI), expiratory time (TE), I:E ratio (E:I when appropriate), inspiratory duty cycle (IDC i.e. TI/total time of a breathing cycle [TTOT]) and rapid shallow breathing index (RBSI i.e. Bf/VT in L) have seldom been reported in CHF patients [9] or compared between patients with these two diseases [9,10], even though they may provide additional breathing information.