Groenland Carline N L, Blijleven Maud A, Ramzi Imane, Dubois Eric A, Heunks Leo, Endeman Henrik, Wils Evert-Jan, Baggen Vivan J M
Department of Intensive Care, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands.
J Clin Med. 2024 May 30;13(11):3242. doi: 10.3390/jcm13113242.
It is unclear whether other cardiac biomarkers than NT-proBNP can be useful in the risk stratification of patients weaning from mechanical ventilation. The aim of this study is to summarize the role of ischemic cardiac biomarkers in predicting spontaneous breathing trial (SBT) or extubation failure. : We systematically searched Embase, MEDLINE, Web of Science, and Cochrane Central for studies published before January 2024 that reported the association between ischemic cardiac biomarkers and SBT or extubation failure. Data were extracted using a standardized form and methodological assessment was performed using the QUIPS tool. Seven observational studies investigating four ischemic cardiac biomarkers (Troponin-T, Troponin-I, CK-MB, Myoglobin) were included. One study reported a higher peak Troponin-I in patients with extubation failure compared to extubation success (50 ng/L [IQR, 20-215] versus 30 ng/L [IQR, 10-86], = 0.01). A second study found that Troponin-I measured before the SBT was higher in patients with SBT failure in comparison to patients with SBT success (100 ± 80 ng/L versus 70 ± 130 ng/L, = 0.03). A third study reported a higher CK-MB measured at the end of the SBT in patients with weaning failure (SBT or extubation failure) in comparison to weaning success (8.77 ± 20.5 ng/mL versus 1.52 ± 1.42 ng/mL, = 0.047). Troponin-T and Myoglobin as well as Troponin-I and CK-MB measured at other time points were not found to be related to SBT or extubation failure. However, most studies were underpowered and with high risk of bias. : The association with SBT or extubation failure is limited for Troponin-I and CK-MB and appears absent for Troponin-T and Myoglobin, but available studies are hampered by significant methodological drawbacks. To more definitively determine the role of ischemic cardiac biomarkers, future studies should prioritize larger sample sizes, including patients at risk of cardiac disease, using stringent SBTs and structured timing of laboratory measurements before and after SBT.
除NT-proBNP外，其他心脏生物标志物是否可用于机械通气撤机患者的风险分层尚不清楚。本研究的目的是总结缺血性心脏生物标志物在预测自主呼吸试验（SBT）或拔管失败中的作用。我们系统检索了Embase、MEDLINE、Web of Science和Cochrane Central，查找2024年1月之前发表的报告缺血性心脏生物标志物与SBT或拔管失败之间关联的研究。使用标准化表格提取数据，并使用QUIPS工具进行方法学评估。纳入了7项观察性研究，这些研究调查了4种缺血性心脏生物标志物（肌钙蛋白T、肌钙蛋白I、肌酸激酶同工酶MB、肌红蛋白）。一项研究报告称，拔管失败患者的肌钙蛋白I峰值高于拔管成功患者（50 ng/L[四分位间距，20 - 215]对30 ng/L[四分位间距，10 - 86]，P = 0.01）。第二项研究发现，SBT失败患者在SBT前测得的肌钙蛋白I高于SBT成功患者（100±80 ng/L对70±130 ng/L，P = 0.03）。第三项研究报告称，撤机失败（SBT或拔管失败）患者在SBT结束时测得的肌酸激酶同工酶MB高于撤机成功患者（8.77±20.5 ng/mL对1.52±1.42 ng/mL，P = 0.047）。在其他时间点测得的肌钙蛋白T和肌红蛋白以及肌钙蛋白I和肌酸激酶同工酶MB与SBT或拔管失败无关。然而，大多数研究样本量不足且存在高偏倚风险。肌钙蛋白I和肌酸激酶同工酶MB与SBT或拔管失败的关联有限，肌钙蛋白T和肌红蛋白似乎无关联，但现有研究存在显著的方法学缺陷。为了更明确地确定缺血性心脏生物标志物的作用，未来的研究应优先采用更大样本量，纳入有心脏病风险的患者，使用严格的SBT，并在SBT前后进行结构化的实验室测量时间安排。
