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Intensive Care Medicine

, Volume 37, Issue 3, pp 477–485 | Cite as

B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin

  • Lluís Zapata
  • Paula Vera
  • Antoni Roglan
  • Ignasi Gich
  • Jordi Ordonez-LlanosEmail author
  • Antoni J. Betbesé
Original

Abstract

Aim

To evaluate and compare BNP and NT-proBNP concentrations to predict weaning failure from mechanical ventilation (MV) due to heart failure (HF) before a spontaneous breathing trial (SBT) and to identify HF as the cause of failure.

Methods

Prospective, observational study in a university hospital. The sample included 100 patients on MV for over 48 h who underwent an SBT. Echocardiography and sampling for natriuretic peptides were performed immediately before and at the end of SBT. HF was diagnosed by pulmonary artery occlusion pressure >18 mm Hg or signs of elevated filling pressures in echocardiography.

Results

Thirty-two patients failed the SBT, 12 due to HF and 20 due to respiratory failure (RF). Before SBT, BNP and NT-proBNP were higher in patients failing due to HF than RF or in successfully weaned patients. Cut-off values using ROC curve analyses to predict HF were 263 ng/L for BNP (p < 0.001) and 1,343 ng/L for NT-proBNP (p = 0.08). BNP and NT-proBNP increased significantly during SBT in patients failing due to HF. Increases in BNP and NT-proBNP of 48 and 21 ng/L, respectively, showed a diagnostic accuracy for HF of 88.9 and 83.3% (p < 0.001). BNP performed better than NT-proBNP for HF prediction (p = 0.01) and diagnosis (p = 0.009).

Conclusion

B-type natriuretic peptides, particularly BNP, can predict weaning failure due to HF before an SBT; increases in natriuretic peptides during SBT are diagnostic of HF as the cause of weaning failure. BNP performs better than NT-proBNP in prediction and diagnosis of HF.

Keywords

Natriuretic peptides Mechanical ventilation Weaning Heart failure Respiratory failure 

Notes

Acknowledgments

We thank Carolyn Newey for editing the manuscript. This work has been done in the framework of the Medicine PhD program of the Universitat Autónoma de Barcelona. Reagents for natriuretic peptides analyses were kindly supplied by Biosite and Roche Diagnostics.

Supplementary material

134_2010_2101_MOESM1_ESM.doc (132 kb)
Supplementary material 1 (DOC 131 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Lluís Zapata
    • 1
  • Paula Vera
    • 1
  • Antoni Roglan
    • 1
  • Ignasi Gich
    • 2
  • Jordi Ordonez-Llanos
    • 3
    Email author
  • Antoni J. Betbesé
    • 1
  1. 1.Intensive Care Department, Institut d’Investigacions Biomédiques, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
  2. 2.Clinical Epidemiology and Statistics Department, Institut d’Investigacions Biomédiques, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
  3. 3.Biochemistry Department, Institut d’Investigacions Biomédiques, Hospital de la Santa Creu i Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain

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