Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial

Chien, Jung-Yien; Lin, Ming‐Chung; Huang, Yuh‐Chin T.; Chien, Yu-Fen; Yu, Chong-Jen; Yang, Pan‐Chyr

doi:10.1097/ccm.0b013e31816f49ac

Cited by 85 publications

(69 citation statements)

References 34 publications

(28 reference statements)

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“…Similar to other researchers, we found that baseline hemodynamic values do not help in predicting weaning outcomes. Chien at al 23 found no difference in baseline BNP levels for patients in whom weaning was unsuccessful, but patients in whom extubation was unsuccessful had significantly higher levels of BNP at the end of the trial. The possibility of managing fluid levels on the basis of BNP levels during weaning was tested by Mekontso-Dessap et al 24 in a randomized control trial.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study

Tanios

Epstein

Sauser

et al. 2016

American Journal of Critical Care

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Section: Discussionmentioning

confidence: 99%

Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study

Tanios

Epstein

Sauser

et al. 2016

American Journal of Critical Care

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“…Incorporating this threshold value of BNP into the routine SBT in a subsequent validation study increased the extubation success rate from 78% to 95%. 45 Even though the above studies did not focus entirely on the HRFF population, these tools could be valuable in this population, which is more likely to have left (systolic and diastolic dysfunction) and right heart dysfunction.…”

Section: Other Methods To Assess Hrff Patientsmentioning

confidence: 99%

“…45 The weaning parameters commonly used in clinical practice assess only the respiratory load during an SBT and do not assess the imposed load on the heart. Studies have shown that measurements of central venous oxygen and serum brain natriuretic peptide (BNP) during an SBT could be useful tools to predict extubation failure due to cardiovascular dysfunction.…”

Section: Other Methods To Assess Hrff Patientsmentioning

confidence: 99%

Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial

2014

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Several patient populations have been identified as high risk for extubation failure despite successful completion of a spontaneous breathing trial (SBT). Extubation failure and subsequent need for emergent re-intubation have been associated with increased morbidity and mortality. In this review, we discuss ways to optimize the value and performance of the SBT in a subgroup of high-risk patients (elderly, cardiac, and/or respiratory failure) to reduce the rate of extubation failure. We recommend the use of T-piece mode, longer duration SBT, and measurement of the rapid shallow breathing index (breathing frequency/tidal volume in L) off ventilatory support to increase the predictive value of the SBT. In addition, measurement of changes in central venous oxygen saturation and serum brain natriuretic peptide, and measurements of mitral inflow and annular velocity using bedside transthoracic echocardiography with tissue Doppler imaging may help guide the clinician in determining who and when to extubate and thus minimize the rate of extubation failure. Arterial blood gas analysis performed at the end of the SBT may help determine who will benefit from prophylactic use of noninvasive ventilatory support postextubation.

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“…11,12 Either BNP or NT-proBNP values may be used to detect cardiac dysfunction during weaning from mechanical ventilation, and may differentiate weaning success from failure. [13][14][15][16] There is a single published study focusing on difficult-to-wean patients with chronic obstructive pulmonary disease, 14 but little is known about the association between plasma NT-proBNP concentration and weaning outcomes in postoperative patients.…”

Section: Introductionmentioning

confidence: 99%

N-terminal prohormone B-type natriuretic peptide and weaning outcome in postoperative patients with pulmonary complications

Liao

Qiu

et al. 2013

J Int Med Res

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Objective: To evaluate the relationship between plasma N-terminal prohormone B-type natriuretic peptide (NT-proBNP) and weaning outcomes, and the ability of NT-proBNP level to predict weaning success, in cancer patients with pulmonary complications undergoing noncardiac major surgeries. Methods: Patients who were mechanically ventilated following postoperative respiratory failure were enrolled. NT-proBNP levels at the end of a 2-h spontaneous breathing trial were measured. Weaning was considered a success in patients who completed the trial and maintained spontaneous breathing following extubation for >48 h. Results: Out of 29 patients, 22 patients weaned successfully but weaning failed in 7 patients. Plasma NT-proBNP was significantly higher in the weaning failure group than in the weaning success group. For predicting weaning success, the optimal NT-proBNP threshold value at the end of the spontaneous breathing trial was <448 ng/l (receiver operating characteristic analysis; sensitivity 68.18%, specificity 85.71%, positive predictive value 93.7% and negative predictive value 46.2%). Conclusion: Measuring NT-proBNP at the end of a spontaneous breathing trial may assist in predicting weaning success, as a noninvasive, quantitative and repeatable indicator of cardiac stress in patients with postsurgical respiratory failure.

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Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial

Abstract: Measuring the percentage change in the BNP level during a SBT may help improve the predictive value of SBT on weaning outcome.

Cited by 85 publications

References 34 publications

Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study

Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study

Ventilator Liberation for High-Risk-for-Failure Patients: Improving Value of the Spontaneous Breathing Trial

N-terminal prohormone B-type natriuretic peptide and weaning outcome in postoperative patients with pulmonary complications

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