Pooled analysis of central venous pressure and brain natriuretic peptide levels in patients with extubation failure
DOI:
https://doi.org/10.31636/pmjua.v7i1.2Keywords:
central venous pressure, brain natriuretic peptide, extubation failure, pooled analysisAbstract
Background: extubation failure is related to prolonged hospital stay, high mortality and care cost. In recent years, cardiovascular insufficiency has been considered as a common cause of failed extubation, and some studies have shown that central venous pressure (CVP) and brain natriuretic peptide (BNP) can predict the extubation outcome. Therefore, we conducted a pooled analysis to evaluate that the CVP and BNP levels in critically ill patients subjected to mechanical ventilation are predictors of extubation failure.
Methods: Three online electronic databases such as web of science, EMBASE, and Cochrane Library are systematically searched up to October 2021. All data are analyzed using Review Manager 5.4. The pooled analysis results were performed depending on standardized mean differences (SMD) with 95 % confidence intervals (CI) of the CVP and BNP levels for each study.
Results: A total of 13 studies with 47 561 participants were included in our study. Our results showed that elevated CVP levels were significantly associated with the risk of failed extubation (SMD: 0.54, 95 % CI: 0.07 to 1.02, P = 0.03). This association also appeared after extubation (SMD: 1.39, 95 % CI: 0.37 to 2.40, P = 0.008), but it did not appear before extubation (SMD: 0.04, 95 % CI: -0.50 to 0.59, P = 0.88). Similarly, Our results also showed that increased BNP levels is closely related to extubation failure (SMD: 0.72, 95 % CI: 0.48 to 0.96, P < 0.00001). This relationship also occurs before (SMD: 0.60, 95 % CI: 0.29 to 0.90, P = 0.0001) and after (SMD: 0.92, 95 % CI: 0.54 to 1.30, P < 0.00001) extubation.
Conclusions: This study showed that elevated CVP and BNP levels are associated with risk of extubation failure in critically ill patients. Compared with CVP level, BNP level is a more sensitive and accurate predictor of extubation failure.
Downloads
References
Perren A, Previsdomini M, Llamas M, Cerutti B, Györik S, Merlani G, Jolliet P. Patients’ prediction of extubation success. Intensive care medicine. 2010 Dec;36(12):2045-52. Available from: https://doi.org/10.1007/s00134-010-1984-4
Harrison AM, Cox AC, Davis S, Piedmonte M, Drummond-Webb JJ, Mee RBB. Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors*. Pediatric Critical Care Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Apr;3(2):148–52. Available from: https://doi.org/10.1097/00130478-200204000-00011
Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, Arboleda-Sánchez JA, Hinojosa-Pérez R, Aguilar-Alonso E, et al. Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery. Respiratory Care [Internet]. Daedalus Enterprises; 2018 Jan 30;63(5):550–7. Available from: https://doi.org/10.4187/respcare.04915
Esteban A. Characteristics and Outcomes in Adult Patients Receiving Mechanical Ventilation; A 28-Day International Study. JAMA [Internet]. American Medical Association (AMA); 2002 Jan 16;287(3):345. Available from: https://doi.org/10.1001/jama.287.3.345
Thille AW, Harrois A, Schortgen F, Brun-Buisson C, Brochard L. Outcomes of extubation failure in medical intensive care unit patients*. Critical Care Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2011 Dec;39(12):2612–8. Available from: https://doi.org/10.1097/ccm.0b013e3182282a5a
Frutos-Vivar F, Ferguson ND, Esteban A, Epstein SK, Arabi Y, Apezteguía C, et al. Risk Factors for Extubation Failure in Patients Following a Successful Spontaneous Breathing Trial. Chest [Internet]. Elsevier BV; 2006 Dec;130(6):1664–71. Available from: https://doi.org/10.1378/chest.130.6.1664
Khamiees M, Raju P, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Predictors of extubation outcome in patients who have successfully completed a spontaneous breathing trial. Chest. 2001 Oct 1;120(4):1262-70. Available from: https://doi.org/10.1378/chest.120.4.1262
Hsieh M-H, Hsieh M-J, Chen C-M, Hsieh C-C, Chao C-M, Lai C-C. An Artificial Neural Network Model for Predicting Successful Extubation in Intensive Care Units. Journal of Clinical Medicine [Internet]. MDPI AG; 2018 Aug 25;7(9):240. Available from: https://doi.org/10.3390/jcm7090240
Frazier SK, Brom H, Widener J, Pender L, Stone KS, Moser DK. Prevalence of myocardial ischemia during mechanical ventilation and weaning and its effects on weaning success. Heart & Lung [Internet]. Elsevier BV; 2006 Nov;35(6):363–73. Available from: https://doi.org/10.1016/j.hrtlng.2005.12.006
Chatila W, Ani S, Guaglianone D, Jacob B, Amoateng-Adjepong Y, Manthous CA. Cardiac Ischemia During Weaning From Mechanical Ventilation. Chest [Internet]. Elsevier BV; 1996 Jun;109(6):1577–83. Available from: https://doi.org/10.1378/chest.109.6.1577
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. European Journal of Epidemiology [Internet]. Springer Science and Business Media LLC; 2010 Jul 22;25(9):603–5. Available from: https://doi.org/10.1007/s10654-010-9491-z
Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Statistical Methods in Medical Research [Internet]. SAGE Publications; 2016 Sep 27;27(6):1785–805. Available from: https://doi.org/10.1177/0962280216669183
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Research Methodology [Internet]. Springer Science and Business Media LLC; 2014 Dec;14(1). Available from: https://doi.org/10.1186/1471-2288-14-135
Zhao Q-Y, Wang H, Luo J-C, Luo M-H, Liu L-P, Yu S-J, et al. Development and Validation of a Machine-Learning Model for Prediction of Extubation Failure in Intensive Care Units. Frontiers in Medicine [Internet]. Frontiers Media SA; 2021 May 17;8. Available from: https://doi.org/10.3389/fmed.2021.676343
Zapata L, Vera P, Roglan A, Gich I, Ordonez-Llanos J, Betbesé AJ. B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive Care Medicine [Internet]. Springer Science and Business Media LLC; 2010 Dec 9;37(3):477–85. Available from: https://doi.org/10.1007/s00134-010-2101-4
Saugel B, Rakette P, Hapfelmeier A, Schultheiss C, Phillip V, Thies P, et al. Prediction of extubation failure in medical intensive care unit patients. Journal of Critical Care [Internet]. Elsevier BV; 2012 Dec;27(6):571–7. Available from: https://doi.org/10.1016/j.jcrc.2012.01.010
Ma G, Liao W, Qiu J, Su Q, Fang Y, Gu B. N-terminal prohormone B-type natriuretic peptide and weaning outcome in postoperative patients with pulmonary complications. Journal of International Medical Research [Internet]. SAGE Publications; 2013 Aug 1;41(5):1612–21. Available from: https://doi.org/10.1177/0300060513490085
Konomi I, Tasoulis A, Kaltsi I, Karatzanos E, Vasileiadis I, Temperikidis P, et al. Left Ventricular Diastolic Dysfunction—An Independent Risk Factor for Weaning Failure from Mechanical Ventilation. Anaesthesia and Intensive Care [Internet]. SAGE Publications; 2016 Jul;44(4):466–73. Available from: https://doi.org/10.1177/0310057x1604400408
Gupta P, McDonald R, Goyal S, Gossett JM, Imamura M, Agarwal A, et al. Extubation failure in infants with shunt-dependent pulmonary blood flow and univentricular physiology. Cardiology in the Young [Internet]. Cambridge University Press (CUP); 2013 Jan 18;24(1):64–72. Available from: https://doi.org/10.1017/s1047951112002181
Dubo S, Valenzuela ED, Aquevedo A, Jibaja M, Berrutti D, Labra C, et al. Early rise in central venous pressure during a spontaneous breathing trial: A promising test to identify patients at high risk of weaning failure? Lionetti V, editor. PLOS ONE [Internet]. Public Library of Science (PLoS); 2019 Dec 5;14(12):e0225181. Available from: https://doi.org/10.1371/journal.pone.0225181
Dodgen AL, Dodgen AC, Swearingen CJ, Gossett JM, Dasgupta R, Butt W, et al. Characteristics and Hemodynamic Effects of Extubation Failure in Children Undergoing Complete Repair for Tetralogy of Fallot. Pediatric Cardiology [Internet]. Springer Science and Business Media LLC; 2013 Mar 5;34(6):1455–62. Available from: https://doi.org/10.1007/s00246-013-0670-z
Farghaly S, Galal M, Hasan AA, Nafady A. Brain natriuretic peptide as a predictor of weaning from mechanical ventilation in patients with respiratory illness. Australian Critical Care [Internet]. Elsevier BV; 2015 Aug;28(3):116–21. Available from: https://doi.org/10.1016/j.aucc.2014.12.002
Maraghi SE, Hosny M, Samir M, Radwan W. Usage of B-type natriuretic peptide for prediction of weaning outcome by spontaneous breathing trial. Egyptian Journal of Chest Diseases and Tuberculosis [Internet]. Medknow; 2014 Jul;63(3):671–8. Available from: https://doi.org/10.1016/j.ejcdt.2014.04.003
Soummer A, Perbet S, Brisson H, Arbelot C, Constantin J-M, Lu Q, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress*. Critical Care Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2012 Jul;40(7):2064–72. Available from: https://doi.org/10.1097/ccm.0b013e31824e68ae
Tanios M, Epstein S, Sauser S, Chi A. Noninvasive Monitoring of Cardiac Output During Weaning From Mechanical Ventilation: A Pilot Study. American Journal of Critical Care [Internet]. AACN Publishing; 2016 May 1;25(3):257–65. Available from: https://doi.org/10.4037/ajcc2016921
Haji K, Haji D, Canty DJ, Royse AG, Green C, Royse CF. The impact of heart, lung and diaphragmatic ultrasound on prediction of failed extubation from mechanical ventilation in critically ill patients: a prospective observational pilot study. Critical Ultrasound Journal [Internet]. Springer Science and Business Media LLC; 2018 Jul 4;10(1). Available from: https://doi.org/10.1186/s13089-018-0096-1
Buda AJ, Pinsky MR, Ingels NB, Daughters GT, Stinson EB, Alderman EL. Effect of Intrathoracic Pressure on Left Ventricular Performance. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 1979 Aug 30;301(9):453–9. Available from: https://doi.org/10.1056/nejm197908303010901
Miro AM, Pinsky MR. Heart-lung interaction. In: Tobin MJ, editor. Principles and practice of mechanical ventilation. New York: McGraw-Hill. 1994:647–71.
Jubran A, Mathru M, Dries D, Tobin MJ. Continuous Recordings of Mixed Venous Oxygen Saturation during Weaning from Mechanical Ventilation and the Ramifications Thereof. American Journal of Respiratory and Critical Care Medicine [Internet]. American Thoracic Society; 1998 Dec;158(6):1763–9. Available from: https://doi.org/10.1164/ajrccm.158.6.9804056
Win HK, Chang S-M, Raizner M, Shah G, Basky FA, Desai U, et al. Percent change in B-type natriuretic peptide levels during treadmill exercise as a screening test for exercise-induced myocardial ischemia. American Heart Journal [Internet]. Elsevier BV; 2005 Oct;150(4):695–700. Available from: https://doi.org/10.1016/j.ahj.2004.12.003
Lara TM, Hajjar LA, de Almeida JP, Fukushima JT, Barbas CSV, Rodrigues ARB, et al. High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery. Clinics [Internet]. Elsevier BV; 2013;68(1):33–8. Available from: https://doi.org/10.6061/clinics/2013(01)oa05
Lemaire F, Teboul J-L, Cinotti L, Giotto G, Abrouk F, Steg G, et al. Acute Left Ventricular Dysfunction during Unsuccessful Weaning from Mechanical Ventilation. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 1988 Aug 1;69(2):171–9. Available from: https://doi.org/10.1097/00000542-198808000-00004
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License
