title: Natriuretic peptide-driven fluid management during ventilator weaning: a randomized controlled trial.
abstract: BACKGROUND
  Difficult weaning from mechanical ventilation is often associated with fluid overload. B-type natriuretic peptide (BNP) has been proposed as a tool for predicting and detecting weaning failure of cardiovascular origin.
  
  
  OBJECTIVE
  To investigate whether fluid management guided by daily BNP plasma concentrations improves weaning outcomes compared with empirical therapy dictated by clinical acumen.
  
  
  METHODS
  In a randomized controlled multicenter study, we allocated 304 patients to either a BNP-driven or physician-driven strategy of fluid management during ventilator weaning. To standardize the weaning process, patients in both groups were ventilated with an automatic computer-driven weaning system. The primary end point was time to successful extubation.
  
  
  RESULTS
  In the BNP-driven group, furosemide and acetazolamide were given more often and in higher doses than in the control group, resulting in a more negative median (interquartile range) fluid balance during weaning (-2,320 [-4,735, 738] vs. -180 [-2,556, 2,832] ml; P < 0.0001). Time to successful extubation was significantly shorter with the BNP-driven strategy (58.6 [23.3, 139.8] vs. 42.4 [20.8, 107.5] h; P = 0.034). The BNP-driven strategy increased the number of ventilator-free days but did not change length of stay or mortality. The effect on weaning time was strongest in patients with left ventricular systolic dysfunction. The two strategies did not differ significantly regarding electrolyte imbalance, renal failure, or shock.
  
  
  CONCLUSIONS
  Our results suggest that a BNP-driven fluid management strategy decreases the duration of weaning without increasing adverse events, especially in patients with left ventricular systolic dysfunction. Clinical trial registered with www.clinicaltrials.gov (NCT00473148).
authors.affiliation: Assistance Publique-Hoˆpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Henri Mondor, Service de Re´animation Me´dicale, Cre´teil, France. armand.dessap@hmn.aphp.fr
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso Dessap
authors.forename: Ferran
authors.initials: F
authors.lastname: Roche-Campo
authors.forename: Achille
authors.initials: A
authors.lastname: Kouatchet
authors.forename: Vinko
authors.initials: V
authors.lastname: Tomicic
authors.forename: Gaetan
authors.initials: G
authors.lastname: Beduneau
authors.forename: Romain
authors.initials: R
authors.lastname: Sonneville
authors.forename: Belen
authors.initials: B
authors.lastname: Cabello
authors.forename: Samir
authors.initials: S
authors.lastname: Jaber
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Diego
authors.initials: D
authors.lastname: Castanares-Zapatero
authors.forename: Jerome
authors.initials: J
authors.lastname: Devaquet
authors.forename: François
authors.initials: F
authors.lastname: Lellouche
authors.forename: Sandrine
authors.initials: S
authors.lastname: Katsahian
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage*; D000368:Aged; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000628:therapy; D014882:Water-Electrolyte Balance / Q000187:drug effects / Q000502:physiology
chemical_list: D004232:Diuretics; D020097:Natriuretic Peptide, Brain; D005665:Furosemide; D000086:Acetazolamide