Which of the following is the best test to predict successful extubation of patient?
|B||Negative inspiratory pressure|
a. Discontinuation of mechanical ventilatory support represents a milestone in the progression to patient recovery in the intensive care unit (ICU).
b. The tobin index (Frequency : Tidal volume ratio), also known as the rapid shallow breathing index (RSBI).
c. It is perhaps the best negative predictive instrument when performed as Yang and Tobin originally described.
d. If the result is less than 105, then there is nearly a 70% chance the patient will pass extubation.
e. If the score is greater than 105, the patient has an approximately 80% chance of failing extubation.
f. Weaning patients off mechanical ventilation in the postoperative period with a Tobin Index > 80 c.L-1.min-1 and < 100 c.L-1.min-1 was associated with elevated risk of postoperative clinical intercurrences after extubation.
g. Patients with a Tobin index > 80 c.L-1.min, advanced age and increased body weight were independent variables of risk of failure to discontinue mechanical ventilation.
h. Because of the lack of sensitivity and specificity of the criteria listed above, significant research effort was devoted to determining clinically useful weaning parameters.
i. Commonly used clinical parameters that predict successful weaning from mechanical ventilation are:-
Parameter Desired value
Respiratory rate Less than 30-38 breaths/minute
Tidal volume 4-6 mL/minute
Minute ventilation 10-15 L/minute
Negative inspiratory force -20 to –30 cm H2O
Maximal inspiratory pressure -15 to –30 cm H2O
Mouth occlusion pressure 100 msec after the
onset of inspiratory effort (P0.1) divided by MIP 0.3
Rapid shallow breathing index (RSBI)
(respiratory rate divided by tidal volumE. 60-105
Rapid shallow breathing index rate
[(RSBI2 – RSBI1)/RSBI1] x 100 Less than 20%
CROP score (an index including compliance, rate, oxygenation and pressurE. 13