Search Results (10)

Background/Objectives: A major importance is now accorded to respiratory muscle weakness resulting from exposure to invasive mechanical ventilation (IMV) in intensive care unit patients. Some authors suggested that Inspiratory Muscle Training (IMT) could increase the chances of weaning off IMV. This systematic review examined the efficacy of IMT on weaning success in mechanically ventilated patients. Methods: A literature search was conducted on PubMed, Cochrane, and PEDro until June 2023. Weaning success, maximum inspiratory pressure (MIP), and Rapid Shallow Breathing Index (RSBI) were the outcome measures included. Results: Seven randomized controlled trials, including 517 participants under IMV for at least 48 h, were included in the review. From a qualitative point of view, a significant increase in MIP and a significant decrease in RSBI were found in the intervention group during the analysis. However, weaning success was the same between the intervention and control groups. No significant association was found between weaning success and the increase of MIP or the decrease of RSBI. Furthermore, it could not be demonstrated that a positive change in MIP or RSBI would increase the weaning success rates. Conclusions: From a qualitative point of view, IMT is effective in increasing MIP and decreasing RSBI. However, IMT has no significant impact on weaning success. Further research is recommended to analyze the effect of IMT on weaning success. Full article

Background: This study analyzed weaning characteristics and assessed the association of clinical and ultrasonographic indices—maximum inspiratory pressure (MIP), rapid shallow breathing index (RSBI), peak flow expiratory (PFE), diaphragm-thickening fraction (DTF), diaphragm thickness (DT), diaphragm excursion (DE), diaphragm-RSBI (D-RSBI), and lung ultrasound (LUS) patterns—with weaning failure. Methods: This retrospective cohort study included critically ill COVID-19 patients aged 18 and older who had been on invasive mechanical ventilation for at least 48 h and undergoing weaning. Exclusion criteria included absence of ultrasound assessments, neuromuscular diseases, and chronic cardio-respiratory dysfunction. Results: Among 61 patients, 44.3% experienced weaning failure, 27.9% failed the spontaneous breathing trial (SBT), 16.4% were re-intubated within 48 h, and 28% required tracheostomy. Weaning failure was associated with prolonged ventilation (29 vs. 7 days, p < 0.001), extended oxygen therapy, longer ICU stays, and higher ICU mortality. These patients had higher pressure support, lower oxygenation levels, a higher RSBI, and a lower MIP. While PEF, DTF, DE, and D-RSBI showed no significant differences, both right and left diaphragm thicknesses and the inspiratory thickness of the left diaphragm were reduced in failure cases. LUS scores were significantly higher before and after SBT in the failure group. Bivariate analysis identified RSBI [OR = 1.04 (95% CI = 1.01–1.07), p = 0.010], MIP [OR = 0.92 (95% CI = 0.86–0.99), p = 0.018], and LUS [OR = 1.15 (95% CI = 0.98–1.35), p = 0.025] as predictors of weaning failure; however, these associations were not confirmed in multivariate analysis. Conclusions: Ultrasound provides supplementary information during weaning, but no definitive association between ultrasound indices and weaning failure was confirmed in this study. Full article

Background and Objectives: Extubation success in ICU patients is crucial for reducing ventilator-associated complications, morbidity, and mortality. The Rapid Shallow Breathing Index (RSBI) is a widely used predictor for weaning from mechanical ventilation. This study aims to determine the predictive value of serial RSBI measurements on extubation success in ICU patients on mechanical ventilation. Materials and Methods: This prospective observational study was conducted on 86 ICU patients at Hitit University between February 2024 and July 2024. Patients were divided into successful and unsuccessful extubation groups. RSBI values were compared between these groups. Results: This study included 86 patients (32 females, 54 males) with a mean age of 54.51 ± 12.1 years. Extubation was successful in 53 patients and unsuccessful in 33. There was no significant difference in age and intubation duration between the groups (p = 0.246, p = 0.210). Significant differences were found in RSBI-1a and RSBI-2 values (p = 0.013, p = 0.011). The median RSBI-2a was 80 in the successful group and 92 in the unsuccessful group (p = 0.001). The ΔRSBI was higher in the unsuccessful group (p = 0.022). ROC analysis identified optimal cut-off values: RSBI-2a ≤ 72 (AUC 0.715) and ΔRSBI ≤ −3 (AUC 0.648). RSBI-2a ≤ 72 increased the likelihood of successful extubation by 10.8 times, while ΔRSBI ≤ −3 increased it by 3.4 times. Using both criteria together increased the likelihood by 28.48 times. Conclusions: Serial RSBI measurement can be an effective tool for predicting extubation success in patients on IMV. These findings suggest that serially measured RSBI may serve as a potential indicator for extubation readiness. Full article

Background: Diaphragmatic dysfunction correlates with weaning failure, highlighting the need to independently assess the diaphragm’s effects on weaning. We modified the rapid shallow breathing index (RSBI), a predictor of successful weaning, by incorporating temporal variables into existing ultrasound-derived diaphragm index to create a simpler index closer to tidal volume. Methods: We conducted a prospective observational study of patients who underwent a spontaneous breathing trial in the medical intensive care unit (ICU) at Severance Hospital between October 2022 and June 2023. Diaphragmatic displacement (DD) and diaphragm inspiratory time (Ti) were measured using lung ultrasonography. The modified RSBI was defined as follows: respiratory rate (RR) divided by DD was defined as D-RSBI, and RR divided by the sum of the products of DD and Ti on both sides was defined as DTi-RSBI. Results: Among the sonographic indices, DTi-RSBI had the highest area under the receiver operating characteristic (ROC) curve of 0.774 in ROC analysis, and a correlation was found between increased DTi-RSBI and unsuccessful extubation in a multivariable logistic regression analysis (adjusted odds ratio 0.02, 95% confidence interval 0.00–0.97). Conclusions: The DTi-RSBI is beneficial in predicting successful weaning in medical ICU patients. Full article

Liberation from mechanical ventilation is of great importance owing to related complications from extended ventilation time. In this prospective multicenter study, we aimed to construct a versatile model for predicting extubation outcomes in critical care settings using obtainable physiological predictors. The study included patients who had been extubated after a successful 30 min spontaneous breathing trial (SBT). A multivariable logistic regression model was constructed to predict extubation outcomes (successful extubation without reintubation and uneventful extubation without reintubation or noninvasive respiratory support) using eight parameters: age, heart failure, respiratory disease, rapid shallow breathing index (RSBI), PaO₂/FIO₂, Glasgow Coma Scale score, fluid balance, and endotracheal suctioning episodes. Of 499 patients, 453 (90.8%) and 328 (65.7%) achieved successful and uneventful extubation, respectively. The areas under the curve for successful and uneventful extubation in the novel prediction model were 0.69 (95% confidence interval (CI), 0.62–0.77) and 0.70 (95% CI, 0.65–0.74), respectively, which were significantly higher than those in the conventional model solely using RSBI (0.58 (95% CI, 0.50–0.66) and 0.54 (95% CI, 0.49–0.60), p = 0.004 and <0.001, respectively). The model was validated using a bootstrap method, and an online application was developed for automatic calculation. Our model, which is based on a combination of generally obtainable parameters, established an accessible method for predicting extubation outcomes after a successful SBT. Full article

Introduction: Septic patients undergoing mechanical ventilation (MV) often experience difficulty in weaning. Th aim of this study was to determine whether inflammatory biomarkers of sepsis could be indicative of the failure or success of spontaneous breathing trial (SBT) in these patients. Methods: Sixty-five patients on MV (42 septic and 23 intubated for other reasons) fulfilling the criteria for SBT were included in the study. Blood samples were collected right before, at the end of (30 min) and 24 h after the SBT. Serum inflammatory mediators associated with sepsis (IL-18, IL-18BP, TNF) were determined and correlated with the outcome of SBT. Results: A successful SBT was achieved in 45 patients (69.2%). Septic patients had a higher percentage of SBT failure as compared to non-septic patients (85% vs. 15%, p = 0.026), with an odds ratio for failing 4.5 times (OR = 4.5 95%CI: 1.16–17.68, p 0.022). IL-18 levels and the relative mRNA expression in serum were significantly higher in septic as compared to non-septic patients (p < 0.05). Sepsis was independently associated with higher serum IL-18 and TNF levels in two time-point GEE models (53–723, p = 0.023 and 0.3–64, p = 0.048, respectively). IL-18BP displayed independent negative association with rapid shallow breathing index (RSBI) (95% CI: −17.6 to −4, p = 0.002). Conclusion: Sustained increased levels of IL-18 and IL-18BP, acknowledged markers of sepsis, were found to be indicative of SBT failure in patients recovering from sepsis. Our results show that, although subclinical, remaining septic inflammation that sustaines for a long time complicates the weaning procedure. Biomarkers for the estimation of the septic burden and the right time for weaning are needed. Full article

This study was aimed at developing a cognitive—econometric model for assessing the effectiveness of the current governmental policies to support enterprises in Russia in the context of pandemic propagation. Using the Granger test and correlation analysis, we formed a system of key indicators that characterizes the economic development of SMEs (small and medium-sized enterprises) in Russia. Based on the revealed causal relationships and correlation coefficients, a model describing the impact of public policy support instruments on SME economic development was built using cognitive modeling. By means of the additive convolution method, the correlation coefficient between the Russia Small Business Index (RSBI) and the COVID-19 prevalence rate was used to predict the 2020 year-end RSBI value. Regarding the RSBI index forecast, the effectiveness of instruments of the state support for SMEs was evaluated. It was determined how much these indicators of the anti-crisis package of measures should change to increase SMEs’ business activities. The developed cognitive model can be utilized by private and governmental institutions to continuously monitor the effectiveness of public policies that support SMEs. It can also be used as a preventive indicator to evaluate the impact of the anti-crisis measures during pandemics and in the case of other exogenous risks threatening SMEs. The originality of the research results was determined by the econometric methods applied to empirically assess the effectiveness and degree of impact of governmental measures on the operation of SMEs under conditions of uncertainty. Full article

Introduction: For patients on prolonged mechanical ventilation (PMV; > 21 days), successful weaning has been attributed to various factors. The aim of this study is to determine the usefulness of the rapid shallow breathing index(RSBI) and other potential predictors of successful weaning in patients unable to wean and requiring extreme PMV at a hospital-based long-term ventilator facility in Israel. Material and ethods: Retrospective analysis of prospectively collected data over 5 years. Results: A total of 150 subjects on PMV, ready to undergo a weaning process, were included in the study. Of them, 60 (40.0%) were males. The mean age of the whole study population was 76.5 years (SD = 13.6; range 22.0–96.0 years). The subjects were on MV for a mean period of 170.1 days (SD = 237.6; range 25.0–1624.0 days). Sixty patients (40%) were successfully weaned. The mean RSBI in the successfully weaned population was 41.9 breaths/min/L (SD = 12.3; range 13.0–80.4 breaths/min/L), in the population where weaning failed, it was 114.8 breaths/min/L (SD = 69.2; range 47.5–450.0 breaths/min/L). By univariate logistic regression analysis, younger age (p < 0.007), female gender (p < 0.001), decreased duration of MV (p < 0.023), re-spiratory rate (p < 0.001) and RSBI (p < 0.001), increased tidal volume/ideal body weight (p < 0.001) and minute ventilation (p < 0.01) were found to be factors that significantly predict successful weaning. By multivariate analysis, increased tidal volume/ /ideal body weight (p < 0.007) and decreased RSBI (p < 0.046) were found to be independent predictors of successful weaning (p < 0.001; R² Nagelkerke = 0.90). Conclusions: Factors independently predicting successful weaning in patients requiring extreme PMV included increased tidal volume/ideal body weight and decreased RSBI. Full article

Four boron-carrying molecules were synthesized and purified. These were found to be (a) relatively neutral with respect to the parent BF derivative and (b) functionalized by donor–acceptor groups resulting in a charge transfer within the molecule. The study discusses the steric effect and the influence of the substitution of the side rings on the surroundings of the boron atom. Electronic structures were characterized by real-space bonding indicators. Hirshfeld surface and energy frameworks tools were applied to examine the crystal packing features. Full article

Besides the traditional indices such as biochemistry, arterial blood gas, rapid shallow breathing index (RSBI), acute physiology and chronic health evaluation (APACHE) II score, this study suggests a data science framework for extubation prediction in the surgical intensive care unit (SICU) and investigates the value of the information our prediction model provides. A data science framework including variable selection (e.g., multivariate adaptive regression splines, stepwise logistic regression and random forest), prediction models (e.g., support vector machine, boosting logistic regression and backpropagation neural network (BPN)) and decision analysis (e.g., Bayesian method) is proposed to identify the important variables and support the extubation decision. An empirical study of a leading hospital in Taiwan in 2015–2016 is conducted to validate the proposed framework. The results show that APACHE II and white blood cells (WBC) are the two most critical variables, and then the priority sequence is eye opening, heart rate, glucose, sodium and hematocrit. BPN with selected variables shows better prediction performance (sensitivity: 0.830; specificity: 0.890; accuracy 0.860) than that with APACHE II or RSBI. The value of information is further investigated and shows that the expected value of experimentation (EVE), 0.652 days (patient staying in the ICU), is saved when comparing with current clinical experience. Furthermore, the maximal value of information occurs in a failure rate around 7.1% and it reveals the “best applicable condition” of the proposed prediction model. The results validate the decision quality and useful information provided by our predicted model. Full article