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Systematic reviews

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Predictive value of diaphragmatic rapid shallow breathing index in mechanical ventilation weaning: a systematic review and meta-analysis

  • Lin-Li Sang1,†
  • Wei-Yun Teng1,†
  • Jie Yang1
  • Liu-Zhao Cao1

1Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, Jiangsu, P. R. China

DOI: 10.22514/sv.2020.16.0119 Vol.17,Issue 4,July 2021 pp.34-41

Submitted: 17 November 2020 Accepted: 16 December 2020

Published: 08 July 2021

*Corresponding Author(s): Liu-Zhao Cao E-mail:

† These authors contributed equally.


Background: Mechanical ventilation weaning is a multifactorial process. D-RSBI cannot only reflect the respiratory function but also the diaphragmatic function with the bedside ultrasound technique.

Objective: This review aimed to assess the predictive value of diaphragmatic rapid shallow breathing index (D-RSBI) of weaning outcome.

Method: Databases were systematically reviewed including PubMed, Cochrane Library, Embase, CNKI and WanFang Data. Sensitivity and specificity were pooled with random effects models.

Results: Nine studies met the inclusion criteria and 568 patients were involved. D-RSBI had a pooled sensitivity of 0.84 and a pooled specificity of 0.87 which predicted weaning success. D-RSBI in the success group was significantly lower than the weaning failure group.

Conclusion: D-RSBI is a sensitive and specific predictor for weaning outcomes in spite of the limitations and heterogeneity among the studies. Further studies focusing on particular disease are needed as well.


Diaphragmatic rapid shallow breathing index; Mechanical ventilation weaning; Predictive parameters; Ultrasonography; Diaphragmatic dysfunction; Outcomes

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Lin-Li Sang,Wei-Yun Teng,Jie Yang,Liu-Zhao Cao. Predictive value of diaphragmatic rapid shallow breathing index in mechanical ventilation weaning: a systematic review and meta-analysis. Signa Vitae. 2021. 17(4);34-41.


[1] Tobin M, Manthous C. Mechanical ventilation. American Journal of Respiratory and Critical Care Medicine. 2017; 196: P3-P4.

[2] Munshi L, Ferguson ND. Weaning from mechanical ventilation. Journal of the American Medical Association. 2018; 320: 1865.

[3] Alessandri F, Pugliese F, Ranieri VM. Mechanical ventilation: we have come a long way but still have a long road ahead. The Lancet Respiratory Medicine. 2017; 5: 922-924.

[4] Goligher EC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, et al. Mechanical ventilation-induced diaphragm atrophy strongly impacts clinical outcomes. American Journal of Respiratory and Critical Care Medicine. 2018; 197: 204-213.

[5] Jaber S, Quintard H, Cinotti R, Asehnoune K, Arnal J, Guitton C, et al. Risk factors and outcomes for airway failure versus non-airway failure in the intensive care unit: a multicenter observational study of 1514 extubation procedures. Critical Care. 2018; 22: 236.

[6] Goutman SA, Hamilton JD, Rubin JM. Use of angle-independent M-mode sonography for assessment of diaphragm displacement. Journal of Ultrasound in Medicine. 2017; 36: 1285-1285.

[7] Theerawit P, Eksombatchai D, Sutherasan Y, Suwatanapongched T, Kiat-boonsri C, Kiatboonsri S. Diaphragmatic parameters by ultrasonography for predicting weaning outcomes. BMC Pulmonary Medicine. 2018; 18: 175.

[8] Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D, et al. Evolution of diaphragm thickness during mechanical ventilation. impact of inspiratory effort. American Journal of Respiratory and Critical Care Medicine. 2015; 192: 1080-1088.

[9] Umbrello M, Formenti P. Ultrasonographic assessment of diaphragm function in critically Ill subjects. Respiratory Care. 2016; 61: 542-555.

[10] Sklar MC, Dres M, Fan E, Rubenfeld GD, Scales DC, Herridge MS, et al. Association of low baseline diaphragm muscle mass with prolonged mechanical ventilation and mortality among critically Ill adults. JAMA Network Open. 2020; 3: e1921520.

[11] Arabi Y, Karthika M, Al Enezi F, Pillai L. Rapid shallow breathing index. Annals of Thoracic Medicine. 2016; 11: 167.

[12] Gonçalves EC, Silva EC, Basile Filho A, Auxiliadora-Martins M, Nicolini EA, Gastaldi AC. Low pressure support changes the rapid shallow breathing index (RSBI) in critically ill patients on mechanical ventilation. Brazilian Journal of Physical Therapy. 2012; 16: 368-374.

[13] Khan MT, Munawar K, Hussain SW, Qadeer A, Saeed ML, Shad ZS, et al. Comparing ultrasound-based diaphragmatic excursion with rapid shallow breathing index as a weaning predictor. Cureus. 2018; 10: e3710.

[14] Dres M, Demoule A. Monitoring diaphragm function in the ICU. Current Opinion in Critical Care. 2020; 26: 18-25.

[15] Spadaro S, Grasso S, Mauri T, Dalla Corte F, Alvisi V, Ragazzi R, et al. Can diaphragmatic ultrasonography performed during the T-tube trial predict weaning failure? The role of diaphragmatic rapid shallow breathing index. Critical Care. 2016; 20: 305.

[16] Klimathianaki M, Vaporidi K, Georgopoulos D. Respiratory muscle dysfunction in COPD: from muscles to cell. Current Drug Targets. 2011; 12: 478-488.

[17] Abbas A, Embarak S, Walaa M, Lutfy S. Role of diaphragmatic rapid shallow breathing index in predicting weaning outcome in patients with acute exacerbation of COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2018; 13: 1655-1661.

[18] Dou ZM, Li H, Zhu L, Chen QM, LI B, Liu J. Predictive value of diaphragm rapid shallow breathing index in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease. Chinese Journal of Respiratory and Critical Care Medicine. 2018; 17: 124-127. (In Chinese)

[19] Fan M, Luo J, Wen H, Ning F, Gao M, Han X. Value of the diaphragm movement index tested by ultrosonography for ventilation weaning. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019; 30: 1041-1045. (In Chinese)

[20] Mowafy SMS, Abdelgalel EF. Diaphragmatic rapid shallow breathing index for predicting weaning outcome from mechanical ventilation: comparison with traditional rapid shallow breathing index. Egyptian Journal of Anaesthesia. 2019; 35: 9-17.

[21] Zhang HX, Gong SJ, Song J, Lu HY, Dong ZZ, Xiao AB, et al. Diaphragmatic ultrasonography in predicting outcome of ventilator weaning in patients with mechanical ventilation. Zhejiang Medical Journal. 2018; 40: 919-923,928.

[22] Wang Zl, Li JG, Deng B, Li Wl, Jiang F. Diagnostic value of diaphragmatic rapid shallow breathing index (D-RSBI)and diaphragm thickening fraction (DTF) in weaning from mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine. 2018; 38: 385-389.

[23] Lin N, Huang QX, Zhang HZ, Chen MQ, Tang L, Lu FF. The predictive value of diaphragm ultrasound for weaning from mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine. 2019; 18: 339- 343.

[24] Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. The New England Journal of Medicine. 1991; 324: 1445-1450.

[25] Baptistella AR, Sarmento FJ, da Silva KR, Baptistella SF, Taglietti M, Zuquello RÁ, et al. Predictive factors of weaning from mechanical ventilation and extubation outcome: a systematic review. Journal of Critical Care. 2018; 48: 56-62.

[26] Khemani RG, Sekayan T, Hotz J, Flink RC, Rafferty GF, Iyer N, et al. Risk factors for pediatric extubation failure. Critical Care Medicine. 2017; 45: e798-e805.

[27] Dot I, Pérez-Teran P, Samper M, Masclans J. Diaphragm dysfunction in mechanically ventilated patients. Archivos de Bronconeumología (English Edition). 2017; 53: 150-156.

[28] Ricoy J, Rodríguez-Núñez N, Álvarez-Dobaño JM, Toubes ME, Riveiro V, Valdés L. Diaphragmatic dysfunction. Pulmonology. 2019; 25: 223-235.

[29] Liu Y, Li L. Ventilator-induced diaphragm dysfunction in critical illness. Experimental Biology and Medicine. 2018; 243: 1331-1339.

[30] DiNino E, Gartman EJ, Sethi JM, McCool FD. Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation. Thorax. 2014; 69: 431-435.

[31] Yamada Y, Ueyama M, Abe T, Araki T, Abe T, Nishino M, et al. Time-resolved quantitative analysis of the diaphragms during tidal breathing in a standing position using dynamic chest radiography with a flat panel detector system (“dynamic X-ray phrenicography”): initial experience in 172 volunteers. Academic Radiology. 2017; 24: 393-400.

[32] Yoo J, Lee SJ, Lee JD, Kim HC. Comparison of clinical utility between diaphragm excursion and thickening change using ultrasonography to predict extubation success. The Korean Journal of Internal Medicine. 2018; 33: 331-339.

[33] Qian Z, Yang M, Li L, Chen Y. Ultrasound assessment of diaphragmatic dysfunction as a predictor of weaning outcome from mechanical ventilation: a systematic review and meta-analysis. BMJ Open. 2018; 8: e021189.

[34] Goncalves EC, Lago AF, Silva EC, Almeida MBD, Basile-Filho A, Gastaldi AC. How mechanical ventilation measurement, cutoff and duration affect rapid shallow breathing index accuracy: a randomized trial. Journal of Clinical Medicine Research. 2017; 9: 289-296.

[35] Zou YJ, Wan ZM, Wu CY, Zhong SB. Value of diaphragm shallow rapid respiratory index in predicting the offline results of mechanical ventilation. J Jinzhou Medical University. 2019; 40: 34-36.

[36] Zhou J, Li H, Tao Z, Fu L, Wang Y, Zhou P. The value of three diaphragm ultrasound indices for ventilator weaning. Journal of Chinese Physician. 2019; 21: 1007-1010,1014.

[37] Pellegrini JAS, Moraes RB, Maccari JG, de Oliveira RP, Savi A, Ribeiro RA, et al. Spontaneous breathing trials with T-piece or pressure support ventilation. Respiratory Care. 2016; 61: 1693-1703.

[38] Burns KEA, Soliman I, Adhikari NKJ, Zwein A, Wong JTY, Gomez-Builes C, et al. Trials directly comparing alternative spontaneous breathing trial techniques: a systematic review and meta-analysis. Critical Care. 2017; 21: 127.

[39] Feng H, Chen B, Tian J, Liu Y. A clinical study about D-RSBI directed weaning in the ICU patients undergoing mechanical ventilation. Chinese Journal of Critical Care Medicine. 2019; 39: 34-37.

[40] Gommers D. Functional residual capacity and absolute lung volume. Current Opinion in Critical Care. 2014; 20: 347-351.

[41] Cammarota G, Sguazzotti I, Zanoni M, Messina A, Colombo D, Vignazia GL, et al. Diaphragmatic ultrasound assessment in subjects with acute hypercapnic respiratory failure admitted to the emergency department. Respiratory Care. 2019; 64: 1469-1477.

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