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VOLUME 12 , ISSUE 4 ( October-December, 2023 ) > List of Articles

Original Article

Yang–Tobin Index and Integrative Weaning Index as Predictors of Successful Weaning from Mechanical Ventilation in Intensive Care Unit

Hemanth Mellahally Shivaraja, Jyothi Chakrabarty, Aarohi H Mitra

Keywords : Extubation, Integrative weaning index, Mechanical ventilation, Rapid shallow breathing index, Weaning

Citation Information : Shivaraja HM, Chakrabarty J, Mitra AH. Yang–Tobin Index and Integrative Weaning Index as Predictors of Successful Weaning from Mechanical Ventilation in Intensive Care Unit. Indian J Respir Care 2023; 12 (4):315-319.

DOI: 10.5005/jp-journals-11010-1076

License: CC BY-NC-SA 4.0

Published Online: 18-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Weaning is the process of liberating the patient from mechanical ventilation. It has been shown that no single weaning index can accurately predict a successful weaning process. Weaning by intensive care physicians’ bedside clinical discretion alone can sometimes lead to extubation failure. Yang–Tobin index, also known as the rapid shallow breathing index (RSBI) and integrative weaning index (IWI), are two of the most commonly used weaning indices in intensive care units (ICUs). We did a comparative study between the two indices for the prediction of successful weaning in mechanically ventilated patients. Materials and methods: We studied 115 patients who were mechanically ventilated for >48 hours and were ready for extubation. We recorded RSBI and IWI at 60 and 120 minutes for all patients, along with other physiological parameters like sequential organ failure assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, age, and mechanical ventilator parameters. The receiver operating characteristic (ROC) curves were calculated to evaluate the predictive performance of both the indexes. Results: We used two different indices (RSBI vs IWI) to predict successful extubation. An RSBI score of 25 was successfully extubated. Of 10 patients who experienced weaning failure and required reintubation within 48 hours, all patients had an IWI of <24. IWI was useful in detecting those patients who passed the spontaneous breathing trial (SBT) but needed reintubation afterward. Conclusion: Results showed both the Yang–Tobin index and IWI can successfully predict the weaning outcomes from the mechanically ventilated patient. The area under the curve (AUC) for the ROC curve for both indices was almost similar, suggesting both are comparable. IWI was useful in detecting those patients who passed the SBT but needed reintubation afterward.

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  1. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29(5):1033–1056. DOI: 10.1183/09031936.00010206
  2. Girard TD, Ely EW. Protocol-driven ventilator weaning: reviewing the evidence. Clin Chest Med 2008;29(2):241–252. DOI: 10.1016/j.ccm.2008.02.004
  3. Eskandar N, Apostolakos MJ. Weaning from mechanical ventilation. Crit Care Clin 2007;23(2):263–274. DOI: 10.1016/j.ccc.2006.12.002
  4. Navalesi P, Bruni A, Garofalo E, et al. Weaning off mechanical ventilation: much less an art, but not yet a science. Ann Transl Med 2019;7(Suppl 8):S353. DOI: 10.21037/atm.2019.09.83
  5. Schweickert WD, Gehlbach BK, Pohlman AS, et al. Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med 2004;32(6):1272–1276. DOI: 10.1097/01.ccm.0000127263.54807.79
  6. Meade M, Guyatt G, Cook D, et al. Predicting success in weaning from mechanical ventilation. Chest 2001;120(6 Suppl):400S–424S. DOI: 10.1378/chest.120.6_suppl.400s
  7. MacIntyre NR, Cook DJ, Ely WE Jr, et al. Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001;120(6 Suppl):375S–395S. DOI: 10.1378/chest.120.6_suppl.375s
  8. MacIntyre N. Ventilator discontinuing process: evidence and guidelines. Crit Care Med 2008;36(1):329–330. DOI: 10.1097/01.CCM.0000297958.82589.E2
  9. Tobin MJ, Jubran A. Meta-analysis under the spotlight: focused on a meta-analysis of ventilator weaning. Crit Care Med 2008;36(1):1–7. DOI: 10.1097/01.CCM.0000297883.04634.11
  10. 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(21):1445–1450. DOI: 10.1056/NEJM199105233242101
  11. Aboussouan LS, Lattin CD, Anne VV. Determinants of time-to-weaning in a specialized respiratory care unit. Chest 2005;128(5):3117–3126. DOI: 10.1378/chest.128.5.3117
  12. Nemer SN, Barbas CS, Caldeira JB, et al. A new integrative weaning index of discontinuation from mechanical ventilation. Crit Care 2009;13(5):R152. DOI: 10.1186/cc8051
  13. Ely EW, Baker AM, Dunagan DP, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996;335(25):1864–1869. DOI: 10.1056/NEJM199612193352502
  14. Stroetz RW, Hubmayr RD. Tidal volume maintenance during weaning with pressure support. Am J Respir Crit Care Med 1995;152(3):1034–1040. DOI: 10.1164/ajrccm.152.3.7663780
  15. Frutos-Vivar F, Ferguson ND, Esteban A, et al. Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 2006;130(6):1664–1671. DOI: 10.1378/chest.130.6.1664
  16. Delisle S, Francoeur M, Albert M, et al. Preliminary evaluation of a new index to predict the outcome of a spontaneous breathing trial. Respir Care 2011;56(10):1500–1505. DOI: 10.4187/respcare.00768
  17. Epstein SK. Routine use of weaning predictors: not so fast. Crit Care 2009;13(5):197. DOI: 10.1186/cc8121
  18. Swets JA. Measuring the accuracy of diagnostic systems. Science 1988;240(4857):1285–1293. DOI: 10.1126/science.3287615
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