PURPOSE: The purpose of this study is to evaluate the role of B-type natriuretic peptide (BNP) levels during the weaning process in cardiothoracic surgical (CTS) patients admitted to an Atlanta LTAC requiring prolonged mechanical ventilation.
METHODS: CTS patients admitted to an LTAC for mechanical ventilation weaning between January 2004 to October 2009 were identified. All patients had undergone CABG and or cardiac valve replacement surgery and required prolonged ventilatory support (> 96 hrs). Medical records of the patients were abstracted for data analysis. BNP values for the proportion of patients weaned from mechanical ventilation were obtained. BNP values obtained 48 hrs prior of their LTAC admission and BNP values after a successful weaning trial (SWT) and before placement on tracheostomy collar were analyzed.
RESULTS: Forty - five CTS patients were transferred to LTAC for weaning from mechanical ventilation. All had undergone tracheostomy. Among 45 patients 37 were on full ventilatory support. Of these, 28 (75.7%) were successfully weaned and decannulated. The average BNP levels on the day of LTAC admission was 1795 pg/mL. The BNP before a SWT was 981 pg/mL or 41% decline in the BNP. There was a significant increase (29%) in the BNP values of the weaning failure group (9 Patients) during the LTAC stay.
CONCLUSION: Most of the CTS patients admitted to the LTAC were successfully weaned from mechanical ventilator. Those patients that were successfully weaned had a significant reduction in BNP during their stay, whereas those not successfully weaned had an increase in BNP during their stay.
CLINICAL IMPLICATIONS: Assessing the trend in BNP reduction can help optimize the weaning process. BNP values before SBT can help predict weaning outcome in cardiothoracic patients who require prolonged ventilation support in the LTAC.
DISCLOSURE: Zeena Nawas, No Financial Disclosure Information; No Product/Research Disclosure Information