Intensive Care Medicine

, Volume 32, Issue 10, pp 1529–1536 | Cite as

B-type natriuretic peptide and weaning from mechanical ventilation

  • Armand Mekontso-DessapEmail author
  • Nicolas de Prost
  • Emmanuelle Girou
  • François Braconnier
  • François Lemaire
  • Christian Brun-Buisson
  • Laurent Brochard



Cardiac function and volume status could play a critical role in the setting of weaning failure. B-type natriuretic peptide (BNP) is a powerful marker of cardiac dysfunction. We assessed the value of BNP during the weaning process.

Design, setting and patients

One hundred and two consecutive patients considered ready to undergo a 1-h weaning trial (T-piece or low-pressure support level) were prospectively included in a medical intensive care unit of a university hospital. Weaning was considered successful if the patient passed the trial and sustained spontaneous breathing for more than 48 h after extubation.


Plasma BNP was measured just before the trial in all patients, and at the end of the trial in the first 60 patients.


Overall, 42 patients (41.2%) failed the weaning process (37 patients failed the trial and 5 failed extubation). Logistic regression analysis identified high BNP level before the trial and the product of airway pressure and breathing frequency during ventilation as independent risk factors for weaning failure. BNP values were not different at the end of the trial. In nine of the patients in whom the weaning process failed, it succeeded on a later occasion after diuretic therapy. Their BNP level before weaning decreased between the two attempts (517 vs 226 pg/ml, p = 0.01). In survivors, BNP level was significantly correlated to weaning duration (rho = 0.52, p < 0.01).


Baseline plasma BNP level before the first weaning attempt is higher in patients with subsequent weaning failure and correlates to weaning duration.


Cardiac insufficiency B-type natriuretic peptide Artificial respiration Spontaneous breathing trial Extubation 

Supplementary material

134_2006_339_MOESM1_ESM.doc (61 kb)
Electronic Supplementary Material (DOC 61K)


  1. 1.
    Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D, Jaeschke RZ, Brun-Buisson C (1998) Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129:433–440PubMedGoogle Scholar
  2. 2.
    Fagon JY, Chastre J, Domart Y, Trouillet JL, Pierre J, Darne C, Gibert C (1989) Nosocomial pneumonia in patients receiving continuous mechanical ventilation. Prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques. Am Rev Respir Dis 139:877–884PubMedGoogle Scholar
  3. 3.
    Esteban A, Alia I, Gordo F, Fernandez R, Solsona JF, Vallverdu I, Macias S, Allegue JM, Blanco J, Carriedo D, Leon M, de la Cal MA, Taboada F, Gonzalez de Velasco J, Palazon E, Carrizosa F, Tomas R, Suarez J, Goldwasser RS (1997) Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 156:459–465PubMedGoogle Scholar
  4. 4.
    Epstein SK, Ciubotaru RL, Wong JB (1997) Effect of failed extubation on the outcome of mechanical ventilation. Chest 112:186–192PubMedGoogle Scholar
  5. 5.
    Jubran A, Tobin MJ (1997) Passive mechanics of lung and chest wall in patients who failed or succeeded in trials of weaning. Am J Respir Crit Care Med 155:916–921PubMedGoogle Scholar
  6. 6.
    Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171–179PubMedCrossRefGoogle Scholar
  7. 7.
    Jubran A, Mathru M, Dries D, Tobin MJ (1998) Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 158:1763–1769PubMedGoogle Scholar
  8. 8.
    de Lemos JA, McGuire DK, Drazner MH (2003) B-type natriuretic peptide in cardiovascular disease. Lancet 362:316–322PubMedCrossRefGoogle Scholar
  9. 9.
    Maeda K, Tsutamoto T, Wada A, Hisanaga T, Kinoshita M (1998) Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J 135:825–832PubMedCrossRefGoogle Scholar
  10. 10.
    Friedl W, Mair J, Thomas S, Pichler M, Puschendorf B (1999) Relationship between natriuretic peptides and hemodynamics in patients with heart failure at rest and after ergometric exercise. Clin Chim Acta 281:121–126PubMedCrossRefGoogle Scholar
  11. 11.
    (1992) [8th consensus conference on resuscitation and emergency medicine. Weaning from mechanical ventilation in adults, predominant neurologic and muscular diseases excluded]. Ann Fr Anesth Reanim 11:120–121Google Scholar
  12. 12.
    MacIntyre NR, Cook DJ, Ely EW, Jr., Epstein SK, Fink JB, Heffner JE, Hess D, Hubmayer RD, Scheinhorn DJ (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120:375S–395SCrossRefGoogle Scholar
  13. 13.
    Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I, et al.(1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 2:358–367PubMedGoogle Scholar
  14. 14.
    Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379PubMedCrossRefGoogle Scholar
  15. 15.
    Harrell FE, Jr., Lee KL, Matchar DB, Reichert TA (1985) Regression models for prognostic prediction: advantages, problems, and suggested solutions. Cancer Treat Rep 69:1071–1077Google Scholar
  16. 16.
    Lubien E, DeMaria A, Krishnaswamy P, Clopton P, Koon J, Kazanegra R, Gardetto N, Wanner E, Maisel AS (2002) Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation 105:595–601PubMedCrossRefGoogle Scholar
  17. 17.
    Yamamoto K, Burnett JC, Jr., Jougasaki M, Nishimura RA, Bailey KR, Saito Y, Nakao K, Redfield MM (1996) Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy. Hypertension 28:988–994PubMedGoogle Scholar
  18. 18.
    Jafri SM, Lavine S, Field BE, Bahorozian MT, Carlson RW (1990) Left ventricular diastolic function in sepsis. Crit Care Med 18:709–714PubMedGoogle Scholar
  19. 19.
    Schmidt H, Rohr D, Bauer H, Bohrer H, Motsch J, Martin E (1997) Changes in intrathoracic fluid volumes during weaning from mechanical ventilation in patients after coronary artery bypass grafting. J Crit Care 12:22–27PubMedCrossRefGoogle Scholar
  20. 20.
    Buda AJ, Pinsky MR, Ingels NB, Jr., Daughters GT, 2nd, Stinson EB, Alderman EL (1979) Effect of intrathoracic pressure on left ventricular performance. N Engl J Med 301:453–459PubMedCrossRefGoogle Scholar
  21. 21.
    Oh TE, Bhatt S, Lin ES, Hutchinson RC, Low JM (1991) Plasma catecholamines and oxygen consumption during weaning from mechanical ventilation. Intensive Care Med 17:199–203PubMedCrossRefGoogle Scholar
  22. 22.
    Delooz HH (1976) Factors influencing successful discontinuance of mechanical ventilation after open heart surgery: a clinical study of 41 patients. Crit Care Med 4:265–270PubMedGoogle Scholar
  23. 23.
    Nagaya N, Nishikimi T, Uematsu M, Satoh T, Kyotani S, Sakamaki F, Kakishita M, Fukushima K, Okano Y, Nakanishi N, Miyatake K, Kangawa K (2000) Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 102:865–870PubMedGoogle Scholar
  24. 24.
    Nagaya N, Ando M, Oya H, Ohkita Y, Kyotani S, Sakamaki F, Nakanishi N (2002) Plasma brain natriuretic peptide as a noninvasive marker for efficacy of pulmonary thromboendarterectomy. Ann Thorac Surg 74:180–184; discussion 184PubMedCrossRefGoogle Scholar
  25. 25.
    Ishii J, Nomura M, Ito M, Naruse H, Mori Y, Wang JH, Ishikawa T, Kurokawa H, Kondo T, Nagamura Y, Ezaki K, Watanabe Y, Hishida H (2000) Plasma concentration of brain natriuretic peptide as a biochemical marker for the evaluation of right ventricular overload and mortality in chronic respiratory disease. Clin Chim Acta 301:19–30PubMedCrossRefGoogle Scholar
  26. 26.
    Upadya A, Tilluckdharry L, Muralidharan V, Amoateng-Adjepong Y, Manthous CA (2005) Fluid balance and weaning outcomes. Intensive Care Med 31:1643–1647PubMedCrossRefGoogle Scholar
  27. 27.
    Maisel AS, Clopton P, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Steg G, Westheim A, Knudsen CW, Perez A, Kazanegra R, Bhalla V, Herrmann HC, Aumont MC, McCullough PA (2004) Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: results from the Breathing Not Properly (BNP) multinational study. Am Heart J 147:1078–1084PubMedCrossRefGoogle Scholar
  28. 28.
    Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC, Jr. (2002) Plasma brain natriuretic peptide concentration: impact of age and gender. J Am Coll Cardiol 40:976–982PubMedCrossRefGoogle Scholar
  29. 29.
    Richard C, Teboul JL, Archambaud F, Hebert JL, Michaut P, Auzepy P (1994) Left ventricular function during weaning of patients with chronic obstructive pulmonary disease. Intensive Care Med 20:181–186PubMedCrossRefGoogle Scholar
  30. 30.
    Demoule A, Lefort Y, Lopes ME, Lemaire F (2004) Successful weaning from mechanical ventilation after coronary angioplasty. Br J Anaesth 93:295–297PubMedCrossRefGoogle Scholar
  31. 31.
    Srivastava S, Chatila W, Amoateng-Adjepong Y, Kanagasegar S, Jacob B, Zarich S, Manthous CA (1999) Myocardial ischemia and weaning failure in patients with coronary artery disease: an update. Crit Care Med 27:2109–2112PubMedCrossRefGoogle Scholar
  32. 32.
    Zakynthinos S, Routsi C, Vassilakopoulos T, Kaltsas P, Zakynthinos E, Kazi D, Roussos C (2005) Differential cardiovascular responses during weaning failure: effects on tissue oxygenation and lactate. Intensive Care Med 31:1634–1642PubMedCrossRefGoogle Scholar
  33. 33.
    Teboul JL, Abrouk F, Lemaire F (1988) Right ventricular function in COPD patients during weaning from mechanical ventilation. Intensive Care Med 14:483–485PubMedCrossRefGoogle Scholar
  34. 34.
    De Backer D, El Haddad P, Preiser JC, Vincent JL (2000) Hemodynamic responses to successful weaning from mechanical ventilation after cardiovascular surgery. Intensive Care Med 26:1201–1206PubMedCrossRefGoogle Scholar
  35. 35.
    Hasegawa K, Fujiwara H, Itoh H, Nakao K, Fujiwara T, Imura H, Kawai C (1991) Light and electron microscopic localization of brain natriuretic peptide in relation to atrial natriuretic peptide in porcine atrium. Immunohistocytochemical study using specific monoclonal antibodies. Circulation 84:1203–1209PubMedGoogle Scholar
  36. 36.
    de Bold AJ, Ma KK, Zhang Y, de Bold ML, Bensimon M, Khoshbaten A (2001) The physiological and pathophysiological modulation of the endocrine function of the heart. Can J Physiol Pharmacol 79:705–714PubMedCrossRefGoogle Scholar
  37. 37.
    Matsumoto N, Akaike M, Nishiuchi T, Kawai H, Saito S (1997) Different secretion profiles of atrial and brain natriuretic peptides after acute volume loading in patients with ischemic heart disease. Acta Cardiol 52:261–272PubMedGoogle Scholar
  38. 38.
    Kazanegra R, Cheng V, Garcia A, Krishnaswamy P, Gardetto N, Clopton P, Maisel A (2001) A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study. J Card Fail 7:21–29PubMedCrossRefGoogle Scholar
  39. 39.
    McCullough PA, Duc P, Omland T, McCord J, Nowak RM, Hollander JE, Herrmann HC, Steg PG, Westheim A, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS (2003) B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study. Am J Kidney Dis 41:571–579PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Armand Mekontso-Dessap
    • 1
    • 4
    Email author
  • Nicolas de Prost
    • 1
  • Emmanuelle Girou
    • 2
  • François Braconnier
    • 3
  • François Lemaire
    • 1
  • Christian Brun-Buisson
    • 1
  • Laurent Brochard
    • 1
    • 4
  1. 1.Medical Intensive Care Unit, Centre Hospitalo-Universitaire Henri MondorAssistance Publique-Hôpitaux de Paris, Université Paris XIICréteil CedexFrance
  2. 2.Infection Control Unit, Centre Hospitalo-Universitaire Henri MondorAssistance Publique-Hôpitaux de Paris, Université Paris XIICréteil CedexFrance
  3. 3.Biochemistry Laboratory, Centre Hospitalo-Universitaire Henri MondorAssistance Publique-Hôpitaux de Paris, Université Paris XIICréteil CedexFrance
  4. 4.INSERM U 651, Centre Hospitalo-Universitaire Henri MondorAssistance Publique-Hôpitaux de Paris, Université Paris XIICréteil CedexFrance

Personalised recommendations