Intensive Care Medicine

, Volume 37, Issue 3, pp 477–485

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

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

DOI: 10.1007/s00134-010-2101-4

Cite this article as:
Zapata, L., Vera, P., Roglan, A. et al. Intensive Care Med (2011) 37: 477. doi:10.1007/s00134-010-2101-4

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 

Supplementary material

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

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
  • 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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