Skip to main content
SpringerLink
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. MacIntyre N (2007) Discontinuing mechanical ventilatory support. Chest 132:1049–1056

    Article  PubMed  Google Scholar 

  2. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (awakening and breathing controlled trial): a randomised controlled trial. Lancet 371:126–134

    Article  PubMed  Google Scholar 

  3. Esteban A, Gordo F, Fernández R, Solsona JF, Vallverdú I, Macías S, Allegue JM, Blanco J, Carriedo D, León M, de la Cal MA, Taboada F, Gonzalez de Velasco J (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 156:459–465

    CAS  PubMed  Google Scholar 

  4. Jubran A, Tobin MJ (1997) Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med 155:906–915

    CAS  PubMed  Google Scholar 

  5. 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 69:171–179

    Article  CAS  PubMed  Google Scholar 

  6. Richard C, Teboul JL (2005) Weaning failure from cardiovascular origin. Intensive Care Med 31:1605–1607

    Article  PubMed  Google Scholar 

  7. Jardin F, Bourdarias JP (1995) Right heart catheterization at bedside: a critical view. Intensive Care Med 21:291–295

    Article  CAS  PubMed  Google Scholar 

  8. Lamia B, Maizel J, Ochagavia A, Chemla D, Osman D, Richard C, Teboul JL (2009) Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med 37:2331–2337

    Article  Google Scholar 

  9. Wiese S, Breyer T, Dragu A, Wakili R, Burkard T, Schmidt-Schweda S, Füchtbauer EM, Dohrmann U, Beyersdorf F, Radicke D, Holubarsch CJ (2000) Gene expression of brain natriuretic peptide in isolated atrial and ventricular human myocardium: influence of angiotensin II and diastolic fiber length. Circulation 102:3074–3079

    CAS  PubMed  Google Scholar 

  10. McCullough PA, Omland T, Maisel AS (2003) B-type natriuretic peptides: a diagnostic breakthrough for clinicians. Rev Cardiovasc Med 4:72–80

    PubMed  Google Scholar 

  11. Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA, Breathing Not Properly Multinational Study Investigators (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161–167

    Article  CAS  PubMed  Google Scholar 

  12. Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, Pinto YM, Richards M (2006) NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J 27:330–337

    Article  CAS  PubMed  Google Scholar 

  13. Vallverdú I, Calaf N, Subirana M, Net A, Benito S, Mancebo J (1998) Clinical characteristics, respiratory functional parameters, and outcome of a two-hour T-piece trial in patients weaning from mechanical ventilation. Am J Respir Crit Care Med 158:1855–1862

    PubMed  Google Scholar 

  14. Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  CAS  PubMed  Google Scholar 

  15. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  CAS  PubMed  Google Scholar 

  16. Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 324:1445–1450

    Article  CAS  PubMed  Google Scholar 

  17. Logeart D, Saudubray C, Beyne P, Thabut G, Ennezat PV, Chavelas C, Zanker C, Bouvier E, Solal AC (2002) Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Cardiol 40:1794–1800

    Article  PubMed  Google Scholar 

  18. Boussuges A, Blanc P, Molenat F, Burnet H, Habib G, Sainty JM (2002) Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit. Crit Care Med 30:362–367

    Article  PubMed  Google Scholar 

  19. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  Google Scholar 

  20. Torres A, Gatell JM, Aznar E, el-Ebiary M, de la Puig Bellacasa J, González J, Ferrer M, Rodriguez-Roisin R (1995) Re-intubation increases the risk of nosocomial pneumonia in patients needing mechanical ventilation. Am J Respir Crit Care Med 152:137–141

    CAS  PubMed  Google Scholar 

  21. Epstein SK (2002) Decision to extubate. Intensive Care Med 28:535–546

    Article  CAS  PubMed  Google Scholar 

  22. Epstein SK (1995) Etiology of extubation failure and the predictive value of the rapid shallow breathing index. Am J Respir Crit Care Med 152:545–549

    CAS  PubMed  Google Scholar 

  23. 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 69:171–179

    Article  CAS  PubMed  Google Scholar 

  24. 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 20:181–186

    Article  CAS  PubMed  Google Scholar 

  25. Chatila W, Ani S, Guaglianone D, Jacob B, Amoateng-Adjepong Y, Manthous CA (1996) Cardiac ischemia during weaning from mechanical ventilation. Chest 109:1577–1583

    Article  CAS  PubMed  Google Scholar 

  26. 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 158:1763–1769

    CAS  PubMed  Google Scholar 

  27. Frutos-Vivar F, Ferguson ND, Esteban A, Epstein SK, Arabi Y, Apezteguía C, González M, Hill NS, Nava S, D’Empaire G, Anzueto A (2006) Risk factors for extubation failure in patients following a successful spontaneous breathing trial. Chest 130:1664–7161

    Article  PubMed  Google Scholar 

  28. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS), Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, de Boisblanc B, Connors AF Jr, Hite RD, Harabin AL (2006) Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 354:2564–2575

    Article  CAS  PubMed  Google Scholar 

  29. Mekontso-Dessap A, de Prost N, Girou E, Braconnier F, Lemaire F, Brun-Buisson C, Brochard L (2006) B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med 32:1529–1536

    Article  CAS  PubMed  Google Scholar 

  30. Chien JY, Lin MS, Huang YC, Chien YF, Yu CJ, Yang PC (2008) Changes in B-type natriuretic peptide improve weaning outcome predicted by spontaneous breathing trial. Crit Care Med 36:1421–1426

    Article  CAS  PubMed  Google Scholar 

  31. 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, Breathing Not Properly Multinational Study Investigators (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 41:571–579

    Article  CAS  PubMed  Google Scholar 

  32. Grasso S, Leone A, De Michele M, Anaclerio R, Cafarelli A, Ancona G, Stripoli T, Bruno F, Pugliese P, Dambrosio M, Dalfino L, Di Serio F, Fiore T (2007) Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease. Crit Care Med 35:96–105

    Article  CAS  PubMed  Google Scholar 

  33. Ait-Oufella H, Tharaux PL, Baudel JL, Vandermeersch S, Meyer P, Tonnellier M, Dussaule JC, Guidet B, Offenstadt G, Maury E (2007) Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study. Intensive Care Med 33:1183–1186

    Article  CAS  PubMed  Google Scholar 

  34. Mair J, Falkensammer G, Poelzl G, Hammerer-Lercher A, Griesmacher A, Pachinger O (2007) B-type natriuretic peptide (BNP) is more sensitive to rapid hemodynamic changes in acute heart failure than N-terminal proBNP. Clin Chim Acta 379:163–166

    Article  CAS  PubMed  Google Scholar 

  35. Pemberton CJ, Johnson ML, Yandle TG, Espiner EA (2000) Deconvolution analysis of cardiac natriuretic peptides during acute volume overload. Hypertension 36:355–359

    CAS  PubMed  Google Scholar 

  36. McLean AS, Huang SJ, Nalos M, Tang B, Stewart DE (2003) The confounding effects of age, gender, serum creatinine, and electrolyte concentrations on plasma B-type natriuretic peptide concentrations in critically ill patients. Crit Care Med 31:2611–2618

    Article  CAS  PubMed  Google Scholar 

Download references

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

Authors and 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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paula Vera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antoni Roglan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ignasi Gich
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jordi Ordonez-Llanos
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antoni J. Betbesé
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jordi Ordonez-Llanos.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 131 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

Search

Navigation