title: 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.
abstract: OBJECTIVE
  To evaluate the utility of serial measurements of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) to detect acute cardiac dysfunction during weaning failure in difficult to wean patients with chronic obstructive pulmonary disease.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  A 14-bed general intensive care unit in a university hospital.
  
  
  METHODS
  Nineteen patients mechanically ventilated for chronic obstructive pulmonary disease exacerbation who were difficult to wean.
  
  
  METHODS
  None.
  
  
  RESULTS
  Cardiac and hemodynamic variables, arterial and central venous blood gas, breathing pattern, respiratory mechanics, indexes of oxygen cost of breathing, and plasma levels of NT-proBNP were measured and analyzed immediately before (baseline) and at the end of a spontaneous breathing trial. Eight of 19 patients (42%) were identified with acute cardiac dysfunction at the end of the weaning trial. Baseline NT-proBNP levels were significantly higher (median 5000, interquartile range 4218 pg/mL) in these patients than in patients without evidence of acute cardiac dysfunction (median 1705, interquartile range 3491 pg/mL). Plasma levels of NT-proBNP increased significantly at the end of the spontaneous breathing trial only in patients with acute cardiac dysfunction (median 12,733, interquartile range 16,456 pg/mL, p < .05). The elevation in NT-proBNP at the end of the weaning trial had a good diagnostic performance in detecting acute cardiac dysfunction, as estimated by area under the receiver operating characteristic curve analysis (area under the curve 0.909, se 0.077, 95% confidence interval 0.69-0.98; p < .0001, cutoff = 184.7 pg/mL).
  
  
  CONCLUSIONS
  Serial measurements of NT-proBNP plasma levels provided a noninvasive manner to detect acute cardiac dysfunction during an unsuccessful weaning trial in difficult to wean patients with chronic obstructive pulmonary disease. The utility of this test as a complement of the standard clinical monitoring of the weaning trial deserves further investigation.
authors.affiliation: Department of Emergency Medicine and Organ Transplantation, University of Bari, Ospedale Policlinico, Piazza Giulio Cesare 11, Bari, Italy. sgrasso@rianima.uniba.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grasso
authors.forename: Antonio
authors.initials: A
authors.lastname: Leone
authors.forename: Michele
authors.initials: M
authors.lastname: De Michele
authors.forename: Roberto
authors.initials: R
authors.lastname: Anaclerio
authors.forename: Aldo
authors.initials: A
authors.lastname: Cafarelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ancona
authors.forename: Tania
authors.initials: T
authors.lastname: Stripoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Bruno
authors.forename: Paolo
authors.initials: P
authors.lastname: Pugliese
authors.forename: Michele
authors.initials: M
authors.lastname: Dambrosio
authors.forename: Lidia
authors.initials: L
authors.lastname: Dalfino
authors.forename: Francesca
authors.initials: F
authors.lastname: Di Serio
authors.forename: Tommaso
authors.initials: T
authors.lastname: Fiore
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001784:Blood Gas Analysis; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010101:Oxygen Consumption; D010446:Peptide Fragments / Q000097:blood*; D010865:Pilot Projects; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000628:therapy; D011659:Pulmonary Gas Exchange; D015656:Respiratory Mechanics; D012680:Sensitivity and Specificity; D013990:Tidal Volume; D015300:Ventilator Weaning; D014939:Work of Breathing
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain