临床医生使用几种措施来确定个别患者是否能耐受机械通气的解放,包括快速浅呼吸指数(RSBI)。
给定不同阈值的不同使用,患者群体,和测量特性,
我们搜索了从开始到2019年9月的6个数据库,并选择了报告RSBI预测成功拔管的准确性的研究.我们提取了研究数据,并独立和一式两份地评估质量。
我们纳入了48项研究,涉及10,946例患者的RSBI测量。预测拔管成功的RSBI<105的集合敏感性是中等的(0.83[95%CI,0.78-0.87],适度的确定性),而特异性较差(0.58[95%CI,0.49-0.66],中度确定性),诊断OR(DORs)为5.91(95%CI,4.09-8.52)。RSBI阈值<80或80至105产生类似的灵敏度,特异性,和DOR。这些发现在多个亚组分析中一致,反映了不同的患者特征和RSBI测量的操作差异。
作为独立测试,RSBI预测拔管成功的敏感性中等,特异性较差.未来的研究应评估其作为接受自主呼吸试验(SBT)的许可标准的作用,这些患者处于通过SBT的中等预测试概率。
PROSPERO;编号::CRD42020149196;网址:www。crd.约克。AC.英国/普华永道/。
Clinicians use several measures to ascertain whether individual patients will tolerate
liberation from mechanical ventilation, including the rapid shallow breathing index (RSBI).
Given varied use of different thresholds, patient populations, and measurement characteristics, how well does RSBI predict successful extubation?
We searched six databases from inception through September 2019 and selected studies reporting the accuracy of RSBI in the prediction of successful extubation. We extracted study data and assessed quality independently and in duplicate.
We included 48 studies involving RSBI measurements of 10,946 patients. Pooled sensitivity for RSBI of < 105 in predicting extubation success was moderate (0.83 [95% CI, 0.78-0.87], moderate certainty), whereas specificity was poor (0.58 [95% CI, 0.49-0.66], moderate certainty) with diagnostic ORs (DORs) of 5.91 (95% CI, 4.09-8.52). RSBI thresholds of < 80 or 80 to 105 yielded similar sensitivity, specificity, and DOR. These findings were consistent across multiple subgroup analyses reflecting different patient characteristics and operational differences in RSBI measurement.
As a stand-alone test, the RSBI has moderate sensitivity and poor specificity for predicting extubation success. Future research should evaluate its role as a permissive criterion to undergo a spontaneous breathing trial (SBT) for patients who are at intermediate pretest probability of passing an SBT.
PROSPERO; No.: CRD42020149196; URL: www.crd.york.ac.uk/prospero/.