Department of Internal Medicine, University Hospital Basel, Petersgraben 4, CH-4031Basel, Switzerland.
Eur J Heart Fail. 2011 Feb;13(2):154-62. doi: 10.1093/eurjhf/hfq188. Epub 2010 Oct 29.
Evaluation and management of patients with hypoxaemic respiratory failure in the intensive care unit (ICU) are difficult. The use of B-type natriuretic peptide (BNP), a quantitative marker of cardiac stress and heart failure (HF), may be helpful. The purpose of this study is to describe the prevalence of causative disorders of hypoxaemic respiratory failure in the ICU and to determine the impact of a BNP-guided diagnostic strategy.
This prospective, multi-centre, randomized, single-blind, controlled trial included 314 ICU patients with hypoxaemic respiratory failure: 159 patients were randomly assigned to a diagnostic strategy involving the measurement of BNP and 155 were assessed in a standard manner. The time to discharge and the total cost of treatment were the primary endpoints. Hypoxaemic respiratory failure was multi-causal in 27% of the patients. Heart failure was the most common diagnosis in both groups. The use of BNP levels, in conjunction with other clinical information, significantly increased the detection of HF in combination with an additional diagnosis (32 vs. 16%, P = 0.001) and also increased the application of HF-specific medical therapy (nitrates: 32 vs. 23%, P < 0.05 and diuretics: 65 vs. 50%, P < 0.01). Time to discharge (median, 13 vs.14 days, P = 0.50) and total cost of treatment (median, US-$6190 vs. 7155, P = 0.24) were comparable in both groups.
Hypoxaemic respiratory failure in the ICU is often a multi-causal disorder. The use of BNP increased the detection of HF, but did not significantly improve patient management as quantified by time to discharge or treatment cost. ClinicalTrials.gov Identifier: NCT00130559.
在重症监护病房（ICU）中，对低氧性呼吸衰竭患者的评估和管理较为困难。B 型利钠肽（BNP）作为一种心脏应激和心力衰竭（HF）的定量标志物，其应用可能具有一定的帮助。本研究旨在描述 ICU 中低氧性呼吸衰竭的病因，并确定 BNP 指导诊断策略的影响。
本前瞻性、多中心、随机、单盲、对照试验纳入了 314 例低氧性呼吸衰竭 ICU 患者：159 例患者被随机分配至采用 BNP 测量的诊断策略组，155 例患者则采用标准方式评估。主要终点为出院时间和治疗总费用。低氧性呼吸衰竭在 27%的患者中为多病因。两组均以心力衰竭为最常见的诊断。BNP 水平与其他临床信息联合应用可显著提高 HF 的检出率（联合其他诊断时为 32% vs. 16%，P = 0.001），并增加 HF 特异性治疗药物的应用（硝酸酯类：32% vs. 23%，P < 0.05 和利尿剂：65% vs. 50%，P < 0.01）。两组患者的出院时间（中位数，13 天 vs. 14 天，P = 0.50）和治疗总费用（中位数，6190 美元 vs. 7155 美元，P = 0.24）相当。
ICU 中的低氧性呼吸衰竭常为多病因疾病。BNP 的应用增加了 HF 的检出率，但并未显著改善患者管理，出院时间或治疗费用并未明显改善。临床试验注册号：NCT00130559。
