Modified rapid shallow breathing index as a predictor of extubating outcomes in critical care pediatric patients

Introduction: The decision for timely intubation and extubation of patients in need of mechanical ventilation is vital. In the Shifa Pediatric Intensive Care Unit (PICU) clinical criteria for spontaneous breathing trial (SBT) is used for extubations. However, no objective calculations are possible in this system. Therefore, the study was designed to find out if modified RSBI could be used reliably as an objective predictor. Methodology: A single-center observational study was carried out in the PICU of Shifa International Hospital from June to December 2023. All children intubated were included after written consent, however, those with Cyanotic Congenital heart disease and congenital lung deformity were excluded. The patients were extubated using SBT, but modified RSBI was also calculated, a score of <6.7 predicted successful extubation while a score of >6.7 predicted failure. Successful and failed extubations were compared to RSBI predictions and accuracy was determined using Sensitivity, specificity, and positive and negative predictive values. Results: In total 75 patients were included in the study, 46 males and 29 females. The mean age for male patients was 6.2 years while for females was 4.8 years. The mean weight was 22.1 kg for males and 17.2 kg for females. 68 patients were successfully extubated. The modified RSBI score had an overall sensitivity of 97.1% and specificity of 85.7% with a PPV of 98.5% and an NPV of 75% with a p-value of <.001. Conclusion: Modified RSBI for Pediatric patients is reliable and objective predictor of successful extubation in PICU patients undergoing mechanical ventilation.