Research letter
Relationship of the Rapid Shallow Breathing Index (RSBI) and capnography successfully at weaning
Ewerton Cousina,1, Elielton de Almeida Machadoa,1, Gustavo Dias Ferreirab,2,
, Marilene Rabuskea,3, Isadora Pisania,4, Márcio Osório Guerreiroa,5, Rafael Bueno Orcyb,2
Corresponding author
gusdiasferreira@gmail.com
Corresponding author. Department of Physiology and Pharmacology, Federal University of Pelotas, Campus Universitário Capão do Leão, Pelotas, RS 96010-900, Brazil. Tel.: +55 53 32757335.
Corresponding author. Department of Physiology and Pharmacology, Federal University of Pelotas, Campus Universitário Capão do Leão, Pelotas, RS 96010-900, Brazil. Tel.: +55 53 32757335.
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Department of Physiology and Pharmacology, Federal University of Pelotas, Campus Universitário Capão do Leão, Pelotas, RS 96010-900, Brazil. Tel.: +55 53 32757335." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The search for physiological indexes which are capable of reproducing predictable success of weaning has not yet produced satisfactory results.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Recognition of the exact time of return to spontaneous ventilation is essential for better prognosis, reducing costs and mortality.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the past, a large number of predictive physiological indicators of successful discontinuation of ventilation support have been developed. These indicators have great sensitivity, but lac specificity, so some patients have had to go back on ventilation assistance, which increases unsuccessful weaning rates.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The Rapid Shallow Breathing Index(RSBI) is the most reliable calculation for predicting weaning success. Alteration in patient voluntary breathing patterns, making it superficial, fast and fatiguing without the aid of ventilatory support will bring RSBI's values above 105, therefore indicating failure to wean and not indicating discontinuation of mechanical ventilation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Capnography is a registration or graphic visualization of the variation of carbon dioxide (CO<span class="elsevierStyleInf">2</span>) in the respiratory cycle performed through a sensor that directly measures the gas concentration. Initially in each expiratory cycle, CO<span class="elsevierStyleInf">2</span> pressure (PCO<span class="elsevierStyleInf">2</span>) is zero. Afterwards, during expiration, alveolar gas elimination begins, increasing PCO<span class="elsevierStyleInf">2</span> values, stabilizing and reaching a plateau. At the end of the exhalation a fall occurs, indicating the beginning of inspiration. The monitor reports CO<span class="elsevierStyleInf">2</span> end-expiratory pressure (PET(CO<span class="elsevierStyleInf">2</span>)) and the waveform.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5,6</span></a> We expected that abnormal capnography and increased PET (CO<span class="elsevierStyleInf">2</span>) would relate with mechanical ventilation weaning failure.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> As there are no studies which show the capnography relevance like physiological predict index, the overall study objective is to identify the relationship between RSBI and capnography with successful withdrawal from artificial ventilatory support.</p><p id="par0025" class="elsevierStylePara elsevierViewall">After being approved by Ethics Committee from UCPel (200884), a cross-sectional study was carried out at the ICU of University Hospital, Pelotas, Brazil.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Patients who had been less than 48<span class="elsevierStyleHsp" style=""></span>hours on mechanical ventilation and had entered a weaning protocol were excluded. Fifteen patients (11 males) had 20 attempts at weaning and participated in this study. The sample was calculated considering a power of 80% and a difference of 30bpm/L in the RSBI averages in the success and failure groups. The indication of mechanical ventilation were acute respiratory failure and comorbidities: two were in cases of stroke, two were enterectomy postoperatives, four of pneumonia, two cases of chronic obstructive pulmonary disease (COPD), two COPD associated with pneumonia, one case of acute renal insufficiency, one postoperative of gut surgery and one case of acute respiratory distress syndrome. The weaning process followed the recommendations of the III Brazilian Consensus of Mechanical Ventilation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The criteria for weaning failure were: RR<span class="elsevierStyleHsp" style=""></span>>35bpm, oxygen saturation<<span class="elsevierStyleHsp" style=""></span>90%, HR<span class="elsevierStyleHsp" style=""></span>>140bpm, SBP<span class="elsevierStyleHsp" style=""></span>>140 or <<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>mmHg and signs of agitation or alteration of consciousness levels.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The weaning indexes evaluated were capnography and RSBI. RSBI is obtained in the first (RSBI1’) and 30th minute (RSBI30’) of mechanical ventilation disconnection. Sensitivity and specificity of RSBI were also evaluated.</p><p id="par0040" class="elsevierStylePara elsevierViewall">For the PET(CO<span class="elsevierStyleInf">2</span>) and the capnography, a capnograph sensor was placed between the orotracheal/tracheostomy tube and the T-tube, which was connected to the Dash® 4000 monitor. Capnography and PET(CO<span class="elsevierStyleInf">2</span>) values were recorded in six breath cycles at five minute intervals up to the total of 30<span class="elsevierStyleHsp" style=""></span>minutes.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on the capnography waves presented by Díez-Picazo,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> the graphics collected were described as normal or altered. Two or more consecutive waves were the criterion to define an altered capnography.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The sample consisted of 15 patients with 20 mechanical ventilation weaning attempts, of which 13(65%) were successful, and 7(35%) were unsuccessful in the process.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The Weaning success group had lower values in the RSBI30’ than the failure group as well as more waves considered normal on capnography(p ≥ 0.05). While variables not related to the success of weaning were: RSBI in the first minute (RSBI1’), duration of mechanical ventilation, PET(CO<span class="elsevierStyleInf">2</span>)1’, PET(CO<span class="elsevierStyleInf">2</span>)5’, PET(CO<span class="elsevierStyleInf">2</span>)10’, PET(CO<span class="elsevierStyleInf">2</span>)15’, PET(CO<span class="elsevierStyleInf">2</span>)20’, PET(CO<span class="elsevierStyleInf">2</span>)25’ and PET(CO<span class="elsevierStyleInf">2</span>)30’(<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Taking into account capnography, the success group had nine normal and four altered capnography waves, while the failure group had one normal and six altered capnography (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="par0065" class="elsevierStylePara elsevierViewall">The RSBI1’ showed regular sensitivity (0.64), low specificity(0.50), positive predictive value of 0.84 and negative predictive value of 0.29, with an accuracy of 65%.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The RSBI30’ showed better results, with regular sensitivity (0.80), regular specificity (0.80), positive predictive value of 0.92 and negative predictive value of 0.57, with an accuracy of 80%(<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The main finding of this study was the association of weaning success with RSBI at 30th minute (RSBI30’) and with the capnography.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The RSBI is the most specific index for predicting success at weaning.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,7</span></a> Despite a good indicator, studies suggest that the RSBI performed in the first two minutes of disconnection cannot predict success or failure at weaning.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">In the literature, Lee,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> presented specificity values of 0.72 and sensitivity of 0.11. Yang & Tobin,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> presented of 0.64 for specificity and 0,97 for sensitivity. We observed the specificity of 0.50 in RSBI1’ and 0.80 in RSBI30’, and sensitivity of RSBI1’ of 0.64 and RSBI30’ of 0.80, showing better indicators after 30<span class="elsevierStyleHsp" style=""></span>minutes of evaluation compared to the first minute.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Our study shows that PET(CO<span class="elsevierStyleInf">2</span>) was not a factor associated with weaning, and that RSBI was related as a predictor after the 30th minute, showing better sensitivity and specificity. In addition, we verified that the analysis of the graphics of capnography can be effective and collaborate in the evaluation of the patient to weaning process.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The limitations of this study are the small sample size and the fact that the analysis of capnography, although done by the same evaluators to maintain parameters, was performed subjectively,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> being limited to the graphic of normal/altered.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics approval</span><p id="par0100" class="elsevierStylePara elsevierViewall">The Human Research Ethics Committee from Catholic University of Pelotas approved this study under number 200884.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Author statement</span><p id="par0105" class="elsevierStylePara elsevierViewall">I affirm that all authors have read and agreed the Statement for Authors.[91]</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethics approval" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Author statement" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of Interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:5 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Physical Therapist.</p>" "identificador" => "fn0005" ] 1 => array:3 [ "etiqueta" => "2" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Department of Physiology.</p>" "identificador" => "fn0010" ] 2 => array:3 [ "etiqueta" => "3" "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Professor Course of Physiotherapy.</p>" "identificador" => "fn0015" ] 3 => array:3 [ "etiqueta" => "4" "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Medicine student of Catholic University of Pelotas.</p>" "identificador" => "fn0020" ] 4 => array:3 [ "etiqueta" => "5" "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Professor Course of Medicine.</p>" "identificador" => "fn0025" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">RSBI: Rapid Shallow Breathing Index; RR: respiratory rate; V<span class="elsevierStyleInf">T</span>: tidal volume; PET(CO<span class="elsevierStyleInf">2</span>): CO<span class="elsevierStyleInf">2</span> end-expiratory pressure; ‘:minute. Results are presented as means<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Success \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Failure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RSBI (RR/V<span class="elsevierStyleInf">T</span>) 1’ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80.34<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>25.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">101.27<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>33.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RSBI (RR/V<span class="elsevierStyleInf">T</span>) 30’ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>23.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">103.48<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.04<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of Vent. (days) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.14<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.39 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PET(CO<span class="elsevierStyleInf">2</span>) 1’ (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.28<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PET(CO<span class="elsevierStyleInf">2</span>) 5’(mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.23<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.71<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.53 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PET(CO<span class="elsevierStyleInf">2</span>) 10’ (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.38<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">31.42<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PET(CO<span class="elsevierStyleInf">2</span>) 15’ (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.57<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PET(CO<span class="elsevierStyleInf">2</span>) 20’ (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.07<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.00<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PET(CO<span class="elsevierStyleInf">2</span>) 25’ (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.69<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.85<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.69 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PET(CO<span class="elsevierStyleInf">2</span>) 30’ (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29.76<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.14<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Capnography</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.05<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Altered \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1864252.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">result with statistical significance (p ≤ 0.05). The Capnography was evaluated by the Fisher's exact test, and the other by the T-student test.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison between success group and failure group in Weaning.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Index \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference value \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Sensitivity</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Specificity \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NPV<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RSBI initial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><<span class="elsevierStyleHsp" style=""></span>105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.50<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RSBI final \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><<span class="elsevierStyleHsp" style=""></span>105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.80<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">**</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1864251.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">up to 0.60 the value can be considered low.</p>" ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "**" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">0.60 to 0.85 the value can be considered regular.</p> <p class="elsevierStyleNotepara" id="npar0020">(***) 0.85 to 1.00 the value can be considered as high.</p>" ] 2 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Positive Predictive Value.</p>" ] 3 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Negative Predictive Value.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Values of sensitivity and specificity, positive and negative predictive values of indexes to weaning success.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "III Consenso brasileiro de ventilação mecânica, desmame e interrupção da ventilação mecânica" ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Pneumol." "fecha" => "2007" "volumen" => "33" "numero" => "2" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid shallow breathing did not predict extubation outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K.H. Lee" 1 => "K.P. Hui" 2 => "T.B. Chan" 3 => "W.C. Tan" 4 => "T.K. Lim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Chest." "fecha" => "1994" "volumen" => "105" "paginaInicial" => "540" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8306759" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "14" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A pilot study of a new test to predict extubation failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.F. Solsona" 1 => "Y. Díaz" 2 => "A. Vázquez" 3 => "M. Pilar Gracia" 4 => "A. Zapatero" 5 => "J. Marrugat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc7783" "Revista" => array:6 [ "tituloSerie" => "Crit Care." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 8 | 26 |
| 2024 October | 73 | 39 | 112 |
| 2024 September | 101 | 52 | 153 |
| 2024 August | 117 | 59 | 176 |
| 2024 July | 114 | 54 | 168 |
| 2024 June | 78 | 40 | 118 |
| 2024 May | 96 | 53 | 149 |
| 2024 April | 85 | 44 | 129 |
| 2024 March | 83 | 32 | 115 |
| 2024 February | 69 | 35 | 104 |
| 2024 January | 60 | 38 | 98 |
| 2023 December | 44 | 25 | 69 |
| 2023 November | 82 | 45 | 127 |
| 2023 October | 68 | 50 | 118 |
| 2023 September | 65 | 35 | 100 |
| 2023 August | 43 | 14 | 57 |
| 2023 July | 52 | 33 | 85 |
| 2023 June | 48 | 21 | 69 |
| 2023 May | 55 | 29 | 84 |
| 2023 April | 42 | 25 | 67 |
| 2023 March | 82 | 43 | 125 |
| 2023 February | 46 | 33 | 79 |
| 2023 January | 19 | 19 | 38 |
| 2022 December | 105 | 36 | 141 |
| 2022 November | 63 | 34 | 97 |
| 2022 October | 81 | 50 | 131 |
| 2022 September | 41 | 37 | 78 |
| 2022 August | 59 | 34 | 93 |
| 2022 July | 57 | 60 | 117 |
| 2022 June | 78 | 34 | 112 |
| 2022 May | 103 | 49 | 152 |
| 2022 April | 53 | 42 | 95 |
| 2022 March | 71 | 59 | 130 |
| 2022 February | 84 | 37 | 121 |
| 2022 January | 71 | 53 | 124 |
| 2021 December | 79 | 49 | 128 |
| 2021 November | 87 | 42 | 129 |
| 2021 October | 73 | 65 | 138 |
| 2021 September | 71 | 47 | 118 |
| 2021 August | 60 | 24 | 84 |
| 2021 July | 86 | 25 | 111 |
| 2021 June | 98 | 33 | 131 |
| 2021 May | 188 | 44 | 232 |
| 2021 April | 398 | 76 | 474 |
| 2021 March | 329 | 58 | 387 |
| 2021 February | 156 | 29 | 185 |
| 2021 January | 142 | 34 | 176 |
| 2020 December | 139 | 13 | 152 |
| 2020 November | 143 | 19 | 162 |
| 2020 October | 86 | 38 | 124 |
| 2020 September | 117 | 44 | 161 |
| 2020 August | 108 | 34 | 142 |
| 2020 July | 112 | 28 | 140 |
| 2020 June | 113 | 25 | 138 |
| 2020 May | 97 | 33 | 130 |
| 2020 April | 130 | 15 | 145 |
| 2020 March | 134 | 29 | 163 |
| 2020 February | 119 | 18 | 137 |
| 2020 January | 110 | 27 | 137 |
| 2019 December | 97 | 30 | 127 |
| 2019 November | 85 | 25 | 110 |
| 2019 October | 89 | 20 | 109 |
| 2019 September | 132 | 19 | 151 |
| 2019 August | 127 | 28 | 155 |
| 2019 July | 128 | 32 | 160 |
| 2019 June | 102 | 17 | 119 |
| 2019 May | 120 | 35 | 155 |
| 2019 April | 126 | 54 | 180 |
| 2019 March | 88 | 38 | 126 |
| 2019 February | 64 | 31 | 95 |
| 2019 January | 81 | 47 | 128 |
| 2018 December | 18 | 12 | 30 |
| 2018 November | 1 | 0 | 1 |
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