The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Jerry R. Lang, Michael Cocchi, Justin Salciccioli, Michael W. Donnino; Beth Israel Deaconess Hospital, Boston, MA

Background: Non-invasive ventilation (NIV) can reduce the need for intubation and the mortality associated with acute respiratory failure (ARF). However there is currently no standard physiologic parameter to predict respiratory failure during NIV. We conducted a prospective observational study to evaluate the effectiveness of an (assisted) rapid shallow breathing index (RSBI) to predict the failure of NIV early in the course of ARF. Methods: We evaluated patients with ARF requiring NIV in either the emergency department or intensive care unit at a large, tertiary care center with approximately 50,000 emergency visits each year and 50 intensive care beds. A non-fatiguing form of ventilatory support was targeted using the Draeger Evita XL in the mask ventilation mode, and the RSBI was calculated after patient was placed on support. The primary endpoint of the study was failure of NIV defined specifically as the need for intubation. The secondary endpoint was in-hospital mortality. After fifteen minutes of NIV, the RSBI was calculated and recorded using the exhaled tidal volume and the RR. The RSBI threshold of 105 was used as a cutoff value for stratification of high risk or low risk for death or intubation. The following parameters were recorded ventilator mode, respiratory rate (RR), exhaled tidal volume (ExVt-exh), inhaled tidal volume (Vt-inh), and minute ventilation (MV) every fifteen minutes for the first hour. Results: We evaluated 77 patients with ARF of which 47% were female with mean age of 69 +/- 16. Of the patients with RSBI > 105, 8/17 (47%) were intubated and 6/17 (35%) died. Of the patients with RSBI < 105, 19/60 (32%) were intubated and 7/60 (12%) died. The p values for intubation and mortality were 0.44 and 0.08 respectively. Conclusion: A RSBI > 105 was associated with a higher mortality and need for intubation in patients with ARF though this did not reach statistical signficance likely due to sample size. Sponsored Research - None