Brain natriuretic peptide as a predictor of weaning from mechanical ventilation in patients with respiratory illness

Farghaly, Shereen; Galal, Mostafa; Hasan, Ali A.; Nafady, Asmaa

doi:10.1016/j.aucc.2014.12.002

Cited by 20 publications

(28 citation statements)

References 30 publications

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“…The finding that a lower P a CO 2 on mechanical ventilation was an independent predictor of successful weaning is more difficult to explain. So far, this variable has been assessed in a single study, in which intubated patients with a successful weaning trial had significantly lower P a CO 2 values on mechanical ventilation compared to patients who failed the SBT [38]. In the present study, although the amount of ventilatory assistance (IPAP, DP, and MP) was lower in successfully weaned patients, they had lower P a CO 2 values on mechanical ventilation.…”

Section: Discussionmentioning

confidence: 48%

Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study

et al. 2020

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Background: Several studies have assessed predictors of weaning and extubation outcome in short-term mechanically ventilated patients, but there are only few studies on predictors of weaning from prolonged mechanical ventilation. Methods: Retrospective, single-center, observational study at a specialized national weaning center in Germany. Patients' medical records were reviewed to obtain data on demographics, comorbidities, respiratory indices, and the result of a prospectively documented, standardized spontaneous breathing trial (SBT) upon admission to the weaning center. Respiratory indices assessed were the ventilatory ratio (VR) and parameters derived from calculated mechanical power (MP). Predictors associated with failure of prolonged weaning and failure of the SBT were assessed using a binary logistic regression model. Results: A total of 263 prolonged mechanically ventilated, tracheotomized patients, treated over a 5-year period were analyzed. After 3 weeks of mechanical ventilation, patients with unsuccessful weaning failed a SBT more frequently and showed significantly increased values for inspiratory positive airway pressure, driving pressure, VR, absolute MP, and MP normalized to predicted body weight and dynamic lung-thorax compliance (LTC-MP). In the logistic regression analyses, variables independently correlated with weaning failure were female gender (adjusted odds ratio 0.532 [95% CI 0.291-0.973]; p = 0.040), obesity (body mass index ≥ 30 kg/m 2 ) (2.595 [1.210-5.562]; p = 0.014), COPD (3.209 [1.563-6.589]; p = 0.002), LTC-MP (3.470 [1.067-11.284]; p = 0.039), P a CO 2 on mechanical ventilation (1.101 [95% CI 1.034-1.173]; p = 0.003), and failure of the SBT (4.702 [2.250-9.825]; p < 0.001). In addition, female gender (0.401 [0.216-0.745]; p = 0.004), ; p = 0.046), and P a CO 2 on mechanical ventilation (1.157 [1.083-1.235]; p < 0.001) were independent risk factors for an unsuccessful SBT. Conclusions: In the present study, the derived predictors of weaning point to a crucial role of the workload imposed on respiratory muscles during spontaneous breathing. Mechanical power normalized to lung-thorax compliance was independently correlated with weaning outcome and may identify patients at high risk for weaning failure.

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Section: Discussionmentioning

confidence: 48%

Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study

et al. 2020

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“…1,5,6 Measurements of lung, muscle and heart performances enhance the ability to predict success (sensitivity) and failure (specificity) of weaning but they are not enough to know for sure the patients who succeed in discontinuing mechanical ventilation. 3 It is a common experience that a patient with a normal heart, lung and muscle parameters fails weaning; why is it so?…”

Section: Dear Editormentioning

confidence: 99%

“…1 They measured brain natriuretic peptide's (BNP) values before and after a 2 h spontaneous breathing trial (SBT) and concluded that increase in the BNP level during a SBT may be a good predictor of weaning failure from mechanical ventilation.…”

Section: Dear Editormentioning

confidence: 99%

Difficult to wean patients

Colombo

2015

Australian Critical Care

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“…The primary inclusion criteria among the researches were patients have subjected to mechanical ventilation for more than 24 hours and were ready to wean. The selected studies were conducted in different departments, including multidisciplinary ICU, 16,19 medical ICU, 9 respiratory ICU 15 and general ICU. 10,11,17,18,20 Most of the studies measured BNP before and at the end of SBT, while two studies measured BNP before SBT, 9,17 and only one measured it after SBT.…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

Association between elevated brain natriuretic peptide levels and weaning failure: A systematic review and meta‐analysis

Tang

Zhao

et al. 2021

Int J Clin Pract

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Objective: Cardiovascular dysfunction has been reported as an important mechanism of weaning failure, and recent data suggest that elevated brain natriuretic peptide (BNP) levels is associated with an increased risk of weaning failure. Therefore, we performed this meta-analysis to evaluate the correlation between elevated BNP levels and weaning failure in critically ill patients subject to mechanical ventilation.Methods: A systematic search in Cochrane Library, Embase, PubMed and Web of Science was performed up to September 25, 2019. Standard mean differences (SMD) and corresponding 95% confidence intervals (CIs) of the BNP levels were calculated for each study.Results: Nine studies with a total number of 589 were included in the final metaanalysis. The results showed that elevated BNP levels were significantly associated with the risk of weaning failure (SMD: 0.76, 95% CI: 0.47 to 1.05, P < .00001). The finding was consistent with the BNP measured before (SMD: 0.68, 95% CI: 0.26 to 1.11, P = .002) or at the end of spontaneous breathing trial (SBT) (SMD: 0.85, 95% CI: 0.52 to 1.18, P < .00001). Conclusions:This meta-analysis showed that increased plasma BNP concentration was associated with weaning failure in ICU patients.

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Brain natriuretic peptide as a predictor of weaning from mechanical ventilation in patients with respiratory illness

Cited by 20 publications

References 30 publications

Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study

Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study

Difficult to wean patients

Association between elevated brain natriuretic peptide levels and weaning failure: A systematic review and meta‐analysis

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