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Question 5#

Which of the following is the best test to predict successful extubation of a patient?

A) Respiratory rate
B) Negative inspiratory pressure
C) Tobin index
D) Minute ventilation

Correct Answer is C

Comment:

Protocol-driven ventilator weaning strategies are successful and have become part of the standard of care. The use of a weaning protocol for patients on mechanical ventilation greater than 48 hours reduces the incidence of ventilator-associated pneumonia (VAP) and the overall length of time on mechanical ventilation. Unfortunately, there is still no reliable way of predicting which patient will be successfully extubated after a weaning program, and the decision for extubation is based on a combination of clinical parameters and measured pulmonary mechanics. The Tobin index (frequency [breaths per minute]/ tidal volume [L] ), also known as the rapid shallow breathing index, is perhaps the best negative predictive instrument. If the result equals less than 105, then there is nearly a 70% chance the patient will pass extubation. If the score is greater than 105, the patient has an approximately 80% chance of failing extubation. Other parameters such as the negative inspiratory force, minute ventilation, and respiratory rate are used, but individually have no better predictive value than the rapid shallow breathing index.