title: Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study.
abstract: 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.
authors.affiliation: Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.
authors.forename: Hafid
authors.initials: H
authors.lastname: Ait-Oufella
authors.affiliation: Hôpital Tenon, INSERM U 702, 4 rue de la Chine, 75020, Paris, France.
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Tharaux
authors.affiliation: Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Baudel
authors.affiliation: Hôpital Tenon, INSERM U 702, 4 rue de la Chine, 75020, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Vandermeersch
authors.affiliation: Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Meyer
authors.affiliation: Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint Antoine, 75571, Paris Cedex 12, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Tonnellier
authors.affiliation: Hôpital Tenon, INSERM U 702, 4 rue de la Chine, 75020, Paris, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Dussaule
authors.affiliation: 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.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.affiliation: 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.
authors.forename: Georges
authors.initials: G
authors.lastname: Offenstadt
authors.affiliation: 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.
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
mesh_terms: 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
chemical_list: D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor