The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

WEANING PROTOCOLS & RSBI: CREATING A FOUNDATION FOR SUCCESSFUL EXTUBATION OF MECHANICALLY VENTILATED PATIENTS.

Deneen LeBlanc, Donald A. Pearman, Richard M. Ford, William Wilson, Timothy A. Morris; Respiratory Care, UC San Diego Medical Center, San Diego, CA

BACKGROUND: The Rapid Shallow Breathing Index (RSBI) is demonstrated to be a pertinent measurement to assess the potential for successful extubation of mechanically ventilated patients. Little has been written regarding how RSBI should be applied as a metric in a comprehensive weaning protocol. At UCSD Medical Center, RTs evaluate patients for spontaneous breathing trials (SBTs) within a physician-approved protocol. As part of that protocol patients are screened for exclusion criteria (i.e., PEEP < 5, FiO2 < 45%, and hemodynamic instability) prior to initiating a 1-2 minute CPAP/PS trial using 0-5 cmH2O of PEEP and 0-5 cmH2O of PS. A RSBI is then calculated to determine if the patient should continue on a minimal CPAP/PS SBT for 2 hours provided their RSBI is below 100. An RSBI above 100 results in the patient being placed on an augmented PS SBT (8-20 cmH2O) for 30 minutes with the intent to re-evaluate in 24 hours. Only patients who successfully complete a 2-hour SBT are evaluated for extubation. We intended to demonstrate that when used in conjunction with an established weaning protocol, RSBI is an effective tool to assess patients'ability to wean from mechanical ventilation. METHODS: Over a 90-day period we collected sprint data on 97 patients placed in the weaning protocol in our adult ICUs. RTs captured data at bedside on standardized weaning flowsheets and manually calculated the RSBI. The data was then assessed to determine RSBI values predictive for successful extubation, which was defined as remaining off the ventilator at least 24-hours after extubation. RESULTS: Data collected registered 89 instances of liberation from the ventilator. Only three patients failed. Our success rate measured 96.6%; RSBIs ranged from 16-100 with 78% of total successful extubations registering RSBIs 20-79. CONCLUSION: RSBI is an effective tool when taken in context of the whole methodology of weaning a patient. A protocol that creates guidelines for precise patient assessment and consistent SBTs sets the foundation for its value as our experience demonstrates.
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