NT-proBNP levels at spontaneous breathing trial help in the prediction of post-extubation respiratory distress.
Summary of "NT-proBNP levels at spontaneous breathing trial help in the prediction of post-extubation respiratory distress."
To evaluate and compare the performance of NT-proBNP levels, plasma protein concentration, hematocrit, and fluid balance for the preceding 24 h in predicting the outcome of the two steps of weaning: (1) spontaneous breathing trial (SBT), (2) extubation.
This was a prospective observational study of 143 patients who were mechanically ventilated for more than 48 h (55 % COPD) and were ready to wean. They underwent an SBT and were extubated when they passed the trial. Immediately before the SBT, we measured the evaluated diagnosis tools.
Of 143 patients, 80 (56 %) passed the SBT and were extubated. Of these, two were reintubated for laryngeal dyspnea, 57 had no respiratory problem during the next 48 h, and 21 developed post-extubation respiratory distress (26 %). Rescue noninvasive ventilation (NIV) prevented reintubation in 15 (71 %). None of the tested diagnosis tools predicted the outcome of the SBT. Patients who developed post-extubation respiratory distress were older, had lower values of plasma protein concentration and higher values of NT-proBNP than those who did not. Only NT-proBNP was an independent predictor of the occurrence of post-extubation respiratory distress (OR 1.2; 95 % CI 1.09-1.4; p = 0.003); the area under the ROC curve for NT-proBNP to predict post-extubation respiratory distress was 0.78 (95 % CI 0.67-0.89; p = 0.0001). NT-proBNP was more accurate to rule out (negative likelihood ratio 0.09 for a cutoff of no greater than 1,000 pg/ml) than to rule in the risk of post-extubation respiratory distress (positive likelihood ratio 3.45 for a cutoff of at least 2,000 pg/ml).
NT-proBNP levels at SBT help in the prediction of post-extubation respiratory distress and could identify the subgroup of extubated patients requiring close observation and/or prophylactic NIV.
Intensive Care Unit, CHU Fattouma Bourguiba Monastir, University of Monastir, 5000, Monastir, Tunisia.
This article was published in the following journal.
Name: Intensive care medicine
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22456769
- DOI: http://dx.doi.org/10.1007/s00134-012-2524-1
Medical and Biotech [MESH] Definitions
Irreversible cessation of all bodily functions, manifested by absence of spontaneous breathing and total loss of cardiovascular and cerebral functions.
Controlled Clinical Trial
Work consisting of a clinical trial involving one or more test treatments, at least one control treatment, specified outcome measures for evaluating the studied intervention, and a bias-free method for assigning patients to the test treatment. The treatment may be drugs, devices, or procedures studied for diagnostic, therapeutic, or prophylactic effectiveness. Control measures include placebos, active medicine, no-treatment, dosage forms and regimens, historical comparisons, etc. When randomization using mathematical techniques, such as the use of a random numbers table, is employed to assign patients to test or control treatments, the trial is characterized as a RANDOMIZED CONTROLLED TRIAL.
Intermittent Positive-pressure Breathing
Application of positive pressure to the inspiratory phase of spontaneous respiration.
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