High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

Abstract

OBJECTIVE:The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery.METHODS:We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h.RESULTS:Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation.CONCLUSIONS:A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period.

Fluid overload at start of continuous renal replacement therapy is associated with poorer clinical condition and outcome: a prospective observational study on the combined use of bioimpedance vector analysis and serum N-terminal pro-B-type natriuretic peptide measurement

“…Previous studies have reported the independent use of BIVA and NT-pro BNP for assessment of fluid or volume status in critically ill patients. This report described that overhydration and abnormal NT-pro BNP levels corresponded to a poorer clinical condition and outcome, which confirmed the roles of these parameters in the assessment of fluid status as reported elsewhere [ 9 - 12 ]. The combination of BIVA and NT-pro BNP was generally used in patients with chronic stable fluid status, such as those receiving maintenance hemodialysis, and was reported to be a good reflection of fluid status with good consistency [ 13 , 14 ].…”

The impact of heart, lung and diaphragmatic ultrasound on prediction of failed extubation from mechanical ventilation in critically ill patients: a prospective observational pilot study

“…It is a 32-amino acid peptide released into the plasma because of cardiomyocytes over-stretch. The role of BNP in weaning from mechanical ventilation is controversial [ 7 , 11 , 44 ]. In our study, there was a weak association with elevated BNP and extubation failure.…”

Value of Combination of Heart, Lung, and Diaphragm Ultrasound in Predicting Weaning Outcome of Mechanical Ventilation

“…The oxygen consumption of the myocardial and respiratory muscle will gradually increase during SBT, which may lead to heart and lung dysfunction [ 20 ]. BNP and RSBI are known markers for myocardial and respiratory muscle function during SBT to assess the feasibility of weaning [ 21 ]. However, the multivariate analysis in this study suggested that only BNP in the clinical indicators was associated with an increased risk of weaning failure.…”