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

Intensive Care Medicine volume 37, pages 477–485 (2011)Cite this article

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.

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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.

Author information

Affiliations

  1. Intensive Care Department, Institut d’Investigacions Biomédiques, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    Lluís Zapata, Paula Vera, Antoni Roglan & Antoni J. Betbesé

  2. Clinical Epidemiology and Statistics Department, Institut d’Investigacions Biomédiques, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    Ignasi Gich

  3. Biochemistry Department, Institut d’Investigacions Biomédiques, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, 08041, Barcelona, Spain

    Jordi Ordonez-Llanos

Authors
  1. Lluís Zapata
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  2. Paula Vera
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  3. Antoni Roglan
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  4. Ignasi Gich
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Correspondence to Jordi Ordonez-Llanos.

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Zapata, L., Vera, P., Roglan, A. et al. B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive Care Med 37, 477–485 (2011). https://doi.org/10.1007/s00134-010-2101-4

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  • DOI: https://doi.org/10.1007/s00134-010-2101-4

Keywords

  • Natriuretic peptides
  • Mechanical ventilation
  • Weaning
  • Heart failure
  • Respiratory failure