Intensive Care Unit, CHU Fattouma Bourguiba Monastir, University of Monastir, 5000, Monastir, Tunisia.
Intensive Care Med. 2012 May;38(5):788-95. doi: 10.1007/s00134-012-2524-1. Epub 2012 Mar 29.
To evaluate and compare the performance of NT-proBNP levels, plasma protein concentration, hematocrit, and fluid balance for the preceding 24 h in predicting the outcome of the two steps of weaning: (1) spontaneous breathing trial (SBT), (2) extubation.
This was a prospective observational study of 143 patients who were mechanically ventilated for more than 48 h (55% COPD) and were ready to wean. They underwent an SBT and were extubated when they passed the trial. Immediately before the SBT, we measured the evaluated diagnosis tools.
Of 143 patients, 80 (56%) passed the SBT and were extubated. Of these, two were reintubated for laryngeal dyspnea, 57 had no respiratory problem during the next 48 h, and 21 developed post-extubation respiratory distress (26%). Rescue noninvasive ventilation (NIV) prevented reintubation in 15 (71%). None of the tested diagnosis tools predicted the outcome of the SBT. Patients who developed post-extubation respiratory distress were older, had lower values of plasma protein concentration and higher values of NT-proBNP than those who did not. Only NT-proBNP was an independent predictor of the occurrence of post-extubation respiratory distress (OR 1.2; 95% CI 1.09-1.4; p = 0.003); the area under the ROC curve for NT-proBNP to predict post-extubation respiratory distress was 0.78 (95% CI 0.67-0.89; p = 0.0001). NT-proBNP was more accurate to rule out (negative likelihood ratio 0.09 for a cutoff of no greater than 1,000 pg/ml) than to rule in the risk of post-extubation respiratory distress (positive likelihood ratio 3.45 for a cutoff of at least 2,000 pg/ml).
NT-proBNP levels at SBT help in the prediction of post-extubation respiratory distress and could identify the subgroup of extubated patients requiring close observation and/or prophylactic NIV.
评估和比较 NT-proBNP 水平、血浆蛋白浓度、红细胞压积和前 24 小时液体平衡在预测两个撤机步骤（1）自主呼吸试验（SBT）、（2）拔管的结果方面的表现。
这是一项对 143 例机械通气超过 48 小时（55%为 COPD 患者）并准备撤机的患者进行的前瞻性观察性研究。他们接受了 SBT，并在通过试验后被拔管。在 SBT 之前，我们测量了评估诊断工具。
143 例患者中，80 例（56%）通过 SBT 并被拔管。其中，2 例因喉痉挛重新插管，57 例在接下来的 48 小时内无呼吸问题，21 例出现拔管后呼吸窘迫（26%）。抢救性无创通气（NIV）预防了 15 例（71%）再插管。在 SBT 中，没有一种测试的诊断工具能预测结果。发生拔管后呼吸窘迫的患者比未发生呼吸窘迫的患者年龄更大，血浆蛋白浓度更低，NT-proBNP 值更高。只有 NT-proBNP 是拔管后呼吸窘迫发生的独立预测因子（OR 1.2；95%CI 1.09-1.4；p = 0.003）；NT-proBNP 预测拔管后呼吸窘迫的 ROC 曲线下面积为 0.78（95%CI 0.67-0.89；p = 0.0001）。NT-proBNP 更准确地排除（截断值不超过 1000 pg/ml 时，阴性似然比为 0.09）而不是纳入（截断值至少 2000 pg/ml 时，阳性似然比为 3.45）拔管后呼吸窘迫的风险。
SBT 时的 NT-proBNP 水平有助于预测拔管后呼吸窘迫，并可确定需要密切观察和/或预防性 NIV 的拔管患者亚组。
