Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease*

Abstract

Serial measurements of NT-proBNP plasma levels provided a noninvasive manner to detect acute cardiac dysfunction during an unsuccessful weaning trial in difficult to wean patients with chronic obstructive pulmonary disease. The utility of this test as a complement of the standard clinical monitoring of the weaning trial deserves further investigation.

Weaning Failure of Cardiac Origin: Recent Advances

“…In our opinion, the divergent results reported by Mekontso-Dessap and colleagues [20] and Grasso and colleagues [21] should urge caution in the use of natriuretic peptide values for diagnosing weaninginduced pulmonary edema. It must be stressed that in neither of these two studies was pulmonary artery catheterization performed to evidence elevation of PAOP during weaning.…”

“…Th eir diagnosis was based on the review of echocardiograms, electrocardiograms (EKGs), and clinical, hemodynamic, gas exchange and respiratory variables obtained at baseline and at the end of the SBT. Interestingly, the elevation of NT-proBNP during a SBT but not the baseline NT-proBNP predicted weaning-induced cardiac dysfunction with an acceptable accuracy [21]. Because of the limited number of patients included in this study, confi rmation in a larger cohort of patients is needed.…”

“…Overall the results reported by MekontsoDessap and colleagues [20] underline the uncertainty of using plasma BNP levels to reliably identify patients who experience weaning failure of cardiac origin. Th e study by Grasso and colleagues [21] evaluated the signifi cance of NT-proBNP in detecting weaning failure of cardiac origin in COPD patients. Th e cardiac origin of weaning failure was determined by one cardiologist and one critical care physician blinded to the results of the NT-proBNP measurements [21].…”

“…Th e study by Grasso and colleagues [21] evaluated the signifi cance of NT-proBNP in detecting weaning failure of cardiac origin in COPD patients. Th e cardiac origin of weaning failure was determined by one cardiologist and one critical care physician blinded to the results of the NT-proBNP measurements [21]. Th eir diagnosis was based on the review of echocardiograms, electrocardiograms (EKGs), and clinical, hemodynamic, gas exchange and respiratory variables obtained at baseline and at the end of the SBT.…”

Tei Index versus Pro BNP as Predictors of Weaning Failure in Mechanically Ventilated Chronic Obstructive Pulmonary Disease Patients

“…Multiple studies have addressed the question of whether BNP or NT-pro-BNP could be used to identify patients who fail to wean for cardiac reasons [7]- [14]. The study by Zapata et al was a prospective observational study of 100MV patients [15].…”