Episode 18 - Rapid Rounds: The Rapid Shallow Breathing Index (RSBI)

Trauma ICU Rounds

Dr. Dennis Kim

Emergency General Surgery, Critical Care, Foam, Intensive Care, Education, Health & Fitness, Science, Life Sciences, Acute Care Surgery, Trauma Surgery, Medicine, Medical Education

4.8 • 663 Ratings

🗓️ 3 July 2020

⏱️ 10 minutes

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Summary

In this Rapid Rounds, we provide a quick and closer look at the Yang & Tobin index as originally described in the 1991 NEJM paper. Support the show

Transcript

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0:00.0	From the classroom to the emergency room, O.R. and beyond. You're joining Trauma ICU Rounds with your host, Dr. Dennis Kim.
0:11.6	Welcome to trauma ICU rounds. I'm your host, Dr. Dennis Kim. Earlier this week, we released an episode on discontinuing mechanical ventilation, and I immediately received
0:21.9	several emails, comments, and questions regarding the utility of the Rapid Shallow Breathing Index
0:27.9	and the original Yang and Tobin paper. More specifically, folks have asked for clarification of what
0:34.1	I meant when I stated that this particular integrative index has not been shown to
0:38.9	decrease duration or weaning of mechanical ventilation. So over the next 10 minutes for today's
0:45.4	rapid rounds, let's take a closer look at the original paper, which was published in the
0:49.6	NEJM, Volume 324, Issue 21, May of 1991. And in my opinion, this is an interesting paper and was
0:59.5	carried out at a time when decisions regarding extubation were left entirely to the physician
1:05.7	team and consensus regarding the optimal method of weaning a patient from ventilatory support didn't really
1:12.2	exist. And there were certainly problems with subjectivity and difficulty standardizing the
1:19.0	approach to discontinuation mechanical ventilation, which led to the development of objective
1:24.6	measures for estimating the success successive weaning from mechanical ventilation.
1:29.9	But this is one of those papers that, yeah, if you have the time, does take a few
1:35.5	reads to fully grasp the methodology and actual meaning of the results.
1:41.0	So the major objective of this single center prospective observational study was to determine
1:46.8	if two integrative indices, the RSBI, and another index, the crop index, which stands for
1:53.7	compliance, rate, oxygenation, and pressure, were more accurate than more traditional
2:00.1	predictive indices that we discussed on our
2:02.5	previous rounds, including minute ventilation or the maximal inspiratory pressure.
2:08.0	And to this end, the study authors performed a prospective observational analysis of 100
2:14.8	medical intensive care unit patients who were intubated for an average of about a week,
	...

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