Natriuretic Peptide–driven Fluid Management during Ventilator Weaning

Dessap, Armand Mekontso; Roche-Campo, Ferrán; Kouatchet, Achille; Tomicić, Vinko; Béduneau, G.; Sonneville, Romain; Cabello, Belén; Jaber, Samir; Azoulay, Élie; Castanares-Zapatero, Diego; Devaquet, Jérôme; Lellouche, François; Katsahian, Sandrine; Brochard, Laurent

doi:10.1164/rccm.201205-0939oc

Cited by 140 publications

(90 citation statements)

References 32 publications

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“…39,40 Echocardiography and serum brain natriuretic peptide levels have been used to assess cardiac dysfunction as a cause of weaning failure. 41,42 Strategies for treatment include afterload reduction with vasodilators, preload reduction with diuretics, and CPAP.…”

Section: Weaning From Mechanical Ventilationmentioning

confidence: 99%

Tracheal ExtubationDiscussion

Artime¹,

Hagberg²

2014

Respir Care

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Tracheal extubation in both the critical care and anesthesia setting is not only an important milestone for patient recovery, but also a procedure that carries a considerable risk of complication or failure. Mechanical ventilation is associated with significant complications that are time-dependent in nature, with a longer duration of intubation resulting in a higher incidence of complications, including ventilator-associated pneumonia, and increased mortality. Extubation failure and subsequent re-intubation are associated with an overall increase in the duration of mechanical ventilation, increased mortality, a greater need for tracheostomy, and higher medical costs. These risks demand that the process of extubation be managed by practitioners with a detailed understanding of the causes of extubation failure and the potential complications. A pre-established extubation plan with considerations made for the possible need for re-intubation is of the utmost importance.

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Section: Weaning From Mechanical Ventilationmentioning

confidence: 99%

Tracheal ExtubationDiscussion

Artime¹,

Hagberg²

2014

Respir Care

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“…These unexpected results might be related to some differences with previous studies. In Antonio et al's study, 3 the mean fluid balance was positive in both groups and higher than in prior studies, 7,8 where all the groups that successfully passed the SBT had a negative balance. The rate of SBT failure was also considerably higher in Antonio et al's study 3 than in the others (20% vs 13%).…”

Section: See the Original Study On Pages 1091 1097mentioning

confidence: 55%

“…Similarly, in a large multicenter observational study, Frutos-Vivar et al 7 reported that one of the risk factors for re-intubation was a positive fluid balance in the 24 h before extubation. Finally, Mekontso Dessap et al 8 reported a multi-center randomized controlled trial comparing the effects of B-type natriuretic peptide-guided versus physician-guided fluid management on weaning outcome. The B-type natriuretic peptide-guided group received more fluid restriction and diuretics, resulting in a more negative median fluid balance during weaning and a shorter time to successful weaning and extubation.…”

Section: See the Original Study On Pages 1091 1097mentioning

confidence: 99%

“…The rate of SBT failure was also considerably higher in Antonio et al's study 3 than in the others (20% vs 13%). 7,8 In this sce-nario, the possible role of negative fluid balance could be obscured by the low number of subjects who actually achieved a negative balance, making it more difficult to know whether other factors that influence extubation failure (eg, weakness, oversedation, heart failure) were more prominent in this group, thus reducing the likelihood of any positive effects of fluid balance emerging. However, their results provide additional evidence that patients with COPD may benefit from negative fluid balance.…”

Section: See the Original Study On Pages 1091 1097mentioning

confidence: 99%

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Weakness and Fluid Overload Hinder Weaning. Or Do They?

Subirá

Fernández

2015

Respir Care

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“…Collaborative research a BNP-driven (n = 152) strategy with a usual care physician-driven (n = 152) strategy of fluid management during ventilator weaning 28 . The BNP-driven group had more negative fluid balance (-2.3 versus -0.2 l; p < 0.001).…”

Section: Barcelona Respiratory Networkmentioning

confidence: 99%

The Process of Weaning from Mechanical Ventilation

Aguirre-Bermeo¹,

Mancebo²

2016

BRN

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Mechanical ventilation is a common process in intensive care units. The weaning period has to be initiated as soon as possible because a delay in recognition that weaning can begin may prolong the duration of mechanical ventilation unnecessarily. The inappropriate management of weaning could influence outcomes; therefore, patients on weaning require continuous attention and intervention. The main objective of this review is to provide a description of the entire scenario and update on outcomes and common recommendations for the correct management of this complex process. The role of modern ventilator modes and non-invasive mechanical ventilation are discussed. Finally, the description and outcomes of a group of patients who have poor outcomes (prolonged weaning group), the importance of their identification, and suggestions for their general management are also presented. (BRN Rev. 2016;2:185-97)

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Natriuretic Peptide–driven Fluid Management during Ventilator Weaning

Abstract: Our results suggest that a BNP-driven fluid management strategy decreases the duration of weaning without increasing adverse events, especially in patients with left ventricular systolic dysfunction. Clinical trial registered with www.clinicaltrials.gov (NCT00473148).

Cited by 140 publications

References 32 publications

Tracheal ExtubationDiscussion

Tracheal ExtubationDiscussion

Weakness and Fluid Overload Hinder Weaning. Or Do They?

The Process of Weaning from Mechanical Ventilation

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