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Weaning from mechanical ventilation: The rapid shallow breathing index

Scott K Epstein, MD
Section Editor
Polly E Parsons, MD
Deputy Editor
Geraldine Finlay, MD


Discontinuing mechanical ventilation is a two step process:

Readiness testing – Readiness testing refers to the evaluation of objective clinical criteria in order to decide whether a patient is ready to begin the process of discontinuing mechanical ventilation. Some clinicians also use physiological tests, known as weaning predictors, to predict whether a patient is ready because they are hesitant to begin weaning on the basis of clinical criteria alone. The rapid shallow breathing index (RSBI) is one of the best studied and most commonly used weaning predictors.

Weaning – Weaning is the process of decreasing ventilator support and allowing patients to assume a greater proportion of their ventilation. It may involve either an immediate shift from full ventilatory support to a period of breathing without assistance from the ventilator (ie, a spontaneous breathing trial [SBT]) or a gradual reduction in the amount of ventilator support [1,2]. Regardless of which approach is chosen, extubation is considered once the patient demonstrates the ability to breathe without the ventilator.

The definition, accuracy, effect on clinical outcomes, and measurement of the RSBI are reviewed here. The role of the RSBI in readiness testing is described separately. (See "Weaning from mechanical ventilation: Readiness testing", section on 'Approach to readiness testing'.)

General aspects of readiness testing, methods of weaning, and extubation are discussed elsewhere. (See "Weaning from mechanical ventilation: Readiness testing" and "Methods of weaning from mechanical ventilation" and "Extubation management".)

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Literature review current through: Oct 2017. | This topic last updated: Sep 12, 2017.
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  1. Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. Spanish Lung Failure Collaborative Group. N Engl J Med 1995; 332:345.
  2. Brochard L, Rauss A, Benito S, et al. Comparison of three methods of gradual withdrawal from ventilatory support during weaning from mechanical ventilation. Am J Respir Crit Care Med 1994; 150:896.
  3. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 1991; 324:1445.
  4. Meade M, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. Chest 2001; 120:400S.
  5. Tobin MJ, Jubran A. Variable performance of weaning-predictor tests: role of Bayes' theorem and spectrum and test-referral bias. Intensive Care Med 2006; 32:2002.
  6. Tanios MA, Nevins ML, Hendra KP, et al. A randomized, controlled trial of the role of weaning predictors in clinical decision making. Crit Care Med 2006; 34:2530.
  7. El-Khatib MF, Zeineldine SM, Jamaleddine GW. Effect of pressure support ventilation and positive end expiratory pressure on the rapid shallow breathing index in intensive care unit patients. Intensive Care Med 2008; 34:505.
  8. Patel KN, Ganatra KD, Bates JH, Young MP. Variation in the rapid shallow breathing index associated with common measurement techniques and conditions. Respir Care 2009; 54:1462.
  9. Kheir F, Myers L, Desai NR, Simeone F. The effect of flow trigger on rapid shallow breathing index measured through the ventilator. J Intensive Care Med 2015; 30:103.
  10. Desai NR, Myers L, Simeone F. Comparison of 3 different methods used to measure the rapid shallow breathing index. J Crit Care 2012; 27:418.e1.
  11. Purro A, Appendini L, De Gaetano A, et al. Physiologic determinants of ventilator dependence in long-term mechanically ventilated patients. Am J Respir Crit Care Med 2000; 161:1115.
  12. Epstein SK, Ciubotaru RL. Influence of gender and endotracheal tube size on preextubation breathing pattern. Am J Respir Crit Care Med 1996; 154:1647.
  13. Seymour CW, Cross BJ, Cooke CR, et al. Physiologic impact of closed-system endotracheal suctioning in spontaneously breathing patients receiving mechanical ventilation. Respir Care 2009; 54:367.