Diaphragmatic Rapid Shallow Breathing Index for predicting successful weaning from mechanical ventilation: A systematic review and meta-analysis

Background

The Diaphragmatic Rapid Shallow Breathing Index (D-RSBI) has been proposed as a promising tool for predicting successful weaning from mechanical ventilation. By focussing on diaphragmatic activity, the D-RSBI aims to overcome the limitations of the classic rapid shallow breathing index, providing a more specific assessment of the patient's ability to sustain independent breathing following extubation.

Methods

Two investigators conducted independent systematic searches in the PubMed, Embase, Cochrane Database, Scopus, Medline, Science Direct, and Epistemonikos databases, covering publications from inception to 30 November 2024. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A meta-analysis was performed using the random-effect model, calculating sensitivity, specificity, diagnostic odds ratio, and the area under the summary receiver operating characteristic curve for the D-RSBI. The systematic review protocol was registered in the Centre for Reviews and Dissemination database 42024582489 of the Prospective International Registry of Systematic Reviews. Subgroup analyses, bivariate meta-regressions, and sensitivity analyses were conducted. Publication bias was evaluated using a funnel plot, along with Begg's and Egger's tests. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology.

Results

Fourteen studies were included in the meta-analysis, comprising a total of 1104 patients. The D-RSBI score was significantly lower in the successful weaning group than in the failure group, with a mean difference of −1.09 (95% confidence interval: -1.36 to −0.82; p < 0.05). The pooled sensitivity was 0.88, specificity was 0.82, and the area under the curve was 0.93. The diagnostic odds ratio was 45.2 (95% confidence interval: 23.5 to 87.2; p < 0.05). The studies included were of moderate to high quality, and the certainty of the evidence was rated as moderate.

Conclusions

The D-RSBI appears to be a promising predictor for forecasting the success of weaning from mechanical ventilation, offering adequate sensitivity and specificity. However, further clinical trials are needed to confirm and validate these findings and thus to establish the score's potential for enhancing the clinical management of weaning in critically ill patients.