Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study.
OBJECTIVE
To assess the cardiac consequences of successful respiratory weaning using the variations of circulating B-type and atrial natriuretic peptides (BNP, ANP) and Doppler mitral flow.


METHODS
A prospective preliminary observational study.


METHODS
A 14-bed medical ICU in a French university hospital.


METHODS
Thirty-one patients undergoing a spontaneous breathing trial on a T-tube.


METHODS
Circulating BNP and ANP levels and Doppler-derived E/A ratio and deceleration time of the E wave were measured before and 1 h after disconnection.


RESULTS
BNP levels increased from 299 pg/ml (range 56-1079) to 412 pg/ml (147-1324) (p=0.02) in patients with systolic left ventricular dysfunction, decreased from 98 pg/ml (25-337) to 45 pg/ml (38-180) (p=0.04) in patients with right ventricular dilation and remained unchanged in patients with neither of these cardiac abnormalities. Overall ANP levels increased from 33 pg/ml to 67 pg/ml (p<0.001) regardless of ventricular function. The E/A ratio increased from 0.91 (0.66-3.56) to 1.17 (0.5-4.76), (p=0.01), after disconnection, whereas deceleration time of E wave decreased from 185 ms (120-280) to 160 ms (70-206) (p=0.02).


CONCLUSIONS
During successful weaning from mechanical ventilation ANP levels increase in all patients whereas changes in BNP levels depend on underlying cardiac function. Changes in Doppler mitral flow indexes following ventilator disconnection suggest an increase in left-ventricular filling pressure.
Ait-Oufella
Hafid
H
Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.
Tharaux
Pierre-Louis
PL
Hôpital Tenon, INSERM U 702, 4 rue de la Chine, 75020, Paris, France.
Baudel
Jean-Luc
JL
Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.
Vandermeersch
Sophie
S
Hôpital Tenon, INSERM U 702, 4 rue de la Chine, 75020, Paris, France.
Meyer
Pascal
P
Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.
Tonnellier
Marc
M
Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.
Dussaule
Jean-Claude
JC
Hôpital Tenon, INSERM U 702, 4 rue de la Chine, 75020, Paris, France.
Guidet
Bertrand
B
Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.|Université Pierre et Marie Curie-Paris 6, UMR S 707, 75012, Paris, France.
Offenstadt
Georges
G
Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.|Université Pierre et Marie Curie-Paris 6, UMR S 707, 75012, Paris, France.
Maury
Eric
E
Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France. eric.maury@sat.ap-hop-paris.fr.|Université Pierre et Marie Curie-Paris 6, UMR S 707, 75012, Paris, France. eric.maury@sat.ap-hop-paris.fr.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D015300:Ventilator Weaning; D016277:Ventricular Function, Left / Q000502:physiology
D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor