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    Patent Pending

    Rapid Shallow Breathing Index (RSBI)

    Predicts successful extubation, to be used only as a single component of the clinical picture.


    Tips for COVID-19: Use to determine floor vs. ICU. Predicts successful extubation.


    Use in intubated patients breathing spontaneously who meet other clinical criteria for weaning from mechanical ventilation. The RSBI should not be the sole determinant of extubation.

    When to Use
    Why Use

    Intubated patients who are breathing spontaneously, such as during a spontaneous breathing trial, and meet other clinical criteria for weaning from mechanical ventilation.

    • The RSBI is one component of a clinical assessment that may help predict success versus failure of extubation.
    • Applies only to patients who are breathing spontaneously, since the formula is based on respiratory rate and tidal volume, which would be artificially dictated by vent settings in modes such as assist control and pressure control.
    • More sensitive than specific (positive RSBI predicts successful extubation better than negative RSBI predicts unsuccessful extubation).
    • Data show that women are more likely than men to have a negative RSBI (predicting failure) independent of actual extubation outcome. Clinicians can use the positive RSBI as an additional supporting data point to for the decision to extubate.
    • Although the RSBI is generally accepted as helpful in predicting success of extubation, there is a dearth of convincing evidence that its application in decision-making leads to a change in outcomes.
    • The RSBI should not be the sole determinant of extubation. Consider other data points before attempting extubation, including:

      • Spontaneous awakening trials (SAT) and spontaneous breathing trials (SBT).
      • Adequacy of gas exchange.
      • Absence of copious secretions.
      • Strength of cough.
      • Hemodynamic stability.
      • Resolution/improvement of pathology that necessitated intubation in the first place.
    • Helps clinicians identify patients at risk for failed extubation.
    • Provides an easily interpretable binary result: positive (<105) predicts success and negative (>105) predicts failure.
    Confirmed positive
    Confirmed negative


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    Creator Insights
    Dr. Karl L. Yang

    About the Creator

    Karl L. Yang, MD, is an associate professor clinical medicine at the Indiana University School of Medicine. He is a practicing physician in sleep medicine and pulmonary critical care. Dr. Yang's primary contributions to the medical literature have been in optimal management of mechanical ventilation.

    To view Dr. Karl L. Yang's publications, visit PubMed

    Are you Dr. Karl L. Yang? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Lubabah Ben-Ghaly, MD
    About the Creator
    Dr. Karl L. Yang
    Are you Dr. Karl L. Yang?
    Content Contributors
    • Lubabah Ben-Ghaly, MD