Transcription of Technique and the Rapid Shallow Breathing Index
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Technique and the Rapid Shallow Breathing Index
Technique and the Rapid Shallow Breathing Index No practice has changed more dramatically during my balance,1 such as upper-airway obstruction or central-ner- career than ventilator weaning. My training in the late vous-system ,11 High RSBIs occur more com- 1980s and early 1990s was often spent at the bedside, monly in the elderly and women with small endotracheal debating whether to wean, when to do it, and which tech- tubes, suggesting that different thresholds for success might nique to use. Experts touted diverse modes and testing be ,13 Finally, practice variation may under- parameters, some rational, some not. mine the RSBI: some respiratory therapists use a T-piece, Fortunately, critical care has evolved since then. The some use continuous positive airway pressure (CPAP), dangers of prolonged intubation are widely recognized, and some use pressure support to measure the RSBI, all of along with mandates to liberate patients quickly once which could impact the measurements Unfor- respiratory failure The focus on gradual wean- tunately, variation in the way the RSBI has been used ing has shifted to using spontaneous Breathing trials for since its original description precludes a simple summary promptly identifying extubation Weaning pro- statement regarding its value and tocols administered by non-physicians have achieved a status close to standard of ,4.
Technique and the Rapid Shallow Breathing Index No practice has changed more dramatically during my career than ventilator weaning. My training in the late
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