61 - Tobin index

Q: Which of the following is the best test to predict succesful extubation of a patient ?

a. Respiratory rate
b. Negative inspiratory pressure
c. Minute ventilation
d. Tobin index

Answer : D

*Unfortunately there is still no truly reliable way of predicting which patient will be succesfully extubated after a weaning program, and the decision for extubation is based on a combination of clinical parameters and measured pulmonary mechanics.

*The TOBIN INDEX  (Frequency : Tidal volume ratio), also known as the RAPID SHALLOW BREATHING INDEX (RSBI), is perhaps the best negative predictive instrument when performed as Yang and Tobin originally described.

*If the result is less than 105, then there is nearly a 70% chance the patient will pass extubation.

*If the score is greater than 105, the patient has an approximately 80% chance of failing extubation.

60 - Glasgow Coma Scale or Score (GCS)

Motor Response  (M)		Verbal Response  (V)		Eye-Opening Response  (E)
Obeys commands	6	Oriented	5	Opens spontaneously	4
Localizes to pain	5	Confused	4	Opens to speech	3
Withdraws from pain	4	Inappropriate words	3	Opens to pain	2
Flexor posturing	3	Unintelligible sounds	2	No eye opening	1
Extensor posturing	2	No sounds	1
No movement	1

^aAdd the three scores to obtain the GlasgowComa Scale score, which can range from 3 to 15. Add "T" after the GCS if intubated and no verbal score is possible. For these patients, the GCS can range from 2T to 10T.