An observational study in Extubation Success, Extubation Failure and Postoperative Respiratory Complications, sponsored by Gaziantep City Hospital. Not yet recruiting. Open to participants aged 18 Years to 80 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-05-13.
Sponsored by Gaziantep City Hospital · Observational
This prospective observational study aims to evaluate the predictive value of the combined use of the rapid shallow breathing index, train-of-four ratio, and bispectral index for extubation success after general anesthesia. Adult patients undergoing elective surgery under general anesthesia and planned for extubation in the operating room will be included.
Before extubation, RSBI, TOF ratio, BIS value, respiratory parameters, and relevant perioperative data will be recorded. The decision to extubate will be made by the attending anesthesiologist according to routine clinical practice and will not be altered by the study protocol. Patients will be followed for 30 minutes after extubation to assess extubation success or the development of complications such as desaturation, laryngospasm, need for airway intervention, mask ventilation, or reintubation.
The primary aim is to determine whether the combined RSBI, TOF, and BIS model predicts extubation success more accurately than each parameter alone.
Safe extubation after general anesthesia requires adequate recovery in several physiological domains, including consciousness, neuromuscular function, and spontaneous ventilation. In routine anesthetic practice, extubation is rarely based on a single variable. Instead, clinicians integrate multiple clinical and monitor-based findings before deciding whether a patient is ready for tracheal extubation.
The bispectral index, train-of-four ratio, and rapid shallow breathing index represent three different components of extubation readiness. BIS reflects the depth of anesthesia and recovery of consciousness, TOF ratio indicates the degree of neuromuscular recovery, and RSBI reflects the adequacy of spontaneous breathing pattern. Although each of these parameters may provide useful information, their combined evaluation may offer a more comprehensive prediction of extubation success.
This prospective observational cohort study will include adult patients undergoing elective surgery under general anesthesia who are planned for extubation in the operating room. The study will be conducted without changing the standard anesthetic management. No randomization or study-related therapeutic intervention will be performed. The final decision to extubate will be made by the attending anesthesiologist according to routine clinical practice and will not be altered by the study protocol.
Pre-extubation data will include demographic variables, ASA physical status, body mass index, type and duration of surgery, anesthetic duration, neuromuscular blocking agent use, reversal agent use, respiratory rate, tidal volume, RSBI, TOF ratio, BIS value, peripheral oxygen saturation, and end-tidal carbon dioxide. RSBI will be calculated as respiratory rate divided by tidal volume in liters. TOF ratio and BIS values will be measured immediately before extubation.
Following extubation, patients will be monitored for 30 minutes for extubation-related respiratory or airway events. Successful extubation will be defined as the absence of reintubation, need for assisted mask ventilation, severe desaturation, laryngospasm, clinically significant respiratory distress, or other airway intervention within 30 minutes after extubation. Problematic extubation will be defined as the presence of any of these events.
The primary outcome of this study is the predictive performance of the combined RSBI, TOF ratio, and BIS model for successful extubation. Secondary outcomes include the individual predictive performance of RSBI, TOF ratio, and BIS; comparison of the combined model with each single-parameter model; extubation time; and the incidence of extubation-related complications such as desaturation, coughing, agitation, laryngospasm, need for airway intervention, assisted ventilation, and reintubation.
The main hypothesis is that the combined evaluation of RSBI, TOF ratio, and BIS provides superior predictive performance for extubation success compared with RSBI, TOF ratio, or BIS alone. Statistical analysis will include comparison of patients with successful and problematic extubation, receiver operating characteristic curve analysis for each parameter, and logistic regression analysis for the combined model. The area under the curve values of the single-parameter models and the combined model will be compared.
Gaziantep City Hospital is the lead sponsor of 21 studies on the registry; 14 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Adult patients undergoing elective surgery under general anesthesia with endotracheal intubation and planned extubation in the operating room will be prospectively enrolled. Patients will be included if pre-extubation RSBI, TOF ratio, and BIS measurements can be obtained and if they provide written informed consent.
Exclusion Criteria:
Adult patients undergoing elective surgery under general anesthesia who are planned for extubation in the operating room will be prospectively observed. Before extubation, RSBI, TOF ratio, and BIS values will be recorded. The decision to extubate will be made by the attending anesthesiologist according to routine clinical practice and will not be altered by the study protocol.
Other: Combined pre-extubation assessment using RSBI, TOF ratio, and BIS
RSBI, TOF ratio, and BIS values will be recorded immediately before extubation as part of the study assessment. RSBI will be calculated using respiratory rate and tidal volume. TOF ratio will be used to assess neuromuscular recovery, and BIS will be used to assess the level of consciousness. These measurements will be evaluated for their predictive value for extubation success. The study protocol will not determine or alter the extubation decision.
Predictive performance of the combined RSBI, TOF ratio, and BIS model for successful extubation
The primary outcome will be the predictive performance of the combined model including rapid shallow breathing index, train-of-four ratio, and bispectral index for successful extubation after general anesthesia. Successful extubation will be defined as the absence of reintubation, need for assisted mask ventilation, severe desaturation, laryngospasm, clinically significant respiratory distress, or other airway intervention within 30 minutes after extubation. The predictive performance of the combined model will be evaluated using receiver operating characteristic curve analysis and the area under the curve.
Time frame: From immediately before extubation to 30 minutes after extubation
Predictive performance of rapid shallow breathing index alone for successful extubation
The predictive value of pre-extubation RSBI alone for successful extubation will be evaluated. RSBI will be calculated as respiratory rate divided by tidal volume in liters. Receiver operating characteristic curve analysis will be performed, and the area under the curve will be calculated.
Time frame: From immediately before extubation to 30 minutes after extubation
Predictive performance of train-of-four ratio alone for successful extubation
The predictive value of pre-extubation TOF ratio alone for successful extubation will be evaluated. TOF ratio will be recorded immediately before extubation. Receiver operating characteristic curve analysis will be performed, and the area under the curve will be calculated.
Time frame: From immediately before extubation to 30 minutes after extubation
Predictive performance of bispectral index alone for successful extubation
The predictive value of pre-extubation BIS alone for successful extubation will be evaluated. BIS value will be recorded immediately before extubation. Receiver operating characteristic curve analysis will be performed, and the area under the curve will be calculated.
Time frame: From immediately before extubation to 30 minutes after extubation
Comparison of the predictive performance of the combined model with single-parameter models
The area under the curve of the combined RSBI, TOF ratio, and BIS model will be compared with the area under the curve values of RSBI, TOF ratio, and BIS individually to determine whether the combined model provides superior predictive performance.
Time frame: From immediately before extubation to 30 minutes after extubation
Incidence of problematic extubation
Problematic extubation will be defined as the occurrence of any of the following within 30 minutes after extubation: severe desaturation, clinically significant respiratory distress, laryngospasm, need for airway intervention, need for assisted mask ventilation, or reintubation.
Time frame: Within 30 minutes after extubation
Number of Participants Requiring Airway Intervention Within 30 Minutes After Extubation
The number of participants requiring any airway intervention within 30 minutes after extubation will be recorded. Airway interventions include airway repositioning, jaw thrust maneuver, oral or nasal airway insertion, assisted mask ventilation, or reintubation.
Time frame: Within 30 minutes after extubation
Incidence of post-extubation desaturation
Post-extubation desaturation will be defined as peripheral oxygen saturation below 92% within 30 minutes after extubation.
Time frame: Within 30 minutes after extubation
No study locations are listed for this record.
Plan to share: No
No publications or documents are linked to this record.
This study is not yet recruiting, as verified in May 2026. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.
Gaziantep City Hospital