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Natriuretic Peptide-Driven Fluid Management during Ventilator Weaning: A Randomized Controlled Trial.
MedLine Citation:
PMID:  22997204     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
RATIONALE: Difficult weaning from mechanical ventilation is often associated with fluid overload. B-type natriuretic peptide (BNP) has been proposed as a tool for predicting and detecting weaning failure of cardiovascular origin. OBJECTIVES: To investigate whether fluid management guided by daily BNP plasma concentrations improves weaning outcomes compared to empirical therapy dictated by clinical acumen. METHODS: In a randomized controlled multicentre study, we allocated 304 patients to a BNP-driven and a physician-driven strategy of fluid management during ventilator weaning. To standardise the weaning process, patients in both groups were ventilated using an automatic computer-driven weaning system. The primary end point was time to successful extubation. Measurements and main results In the BNP-driven group, furosemide and acetazolamide were given more often and in higher doses than in the control group, resulting in a more negative median (interquartile range) fluid balance during weaning (-2320 (-4735, 738) mL vs. -180 (-2556, 2832) mL, p<0.0001). Time to successful extubation was significantly shorter with the BNP-driven strategy (58.6 (23.3, 139.8) hours vs. 42.4 (20.8, 107.5) hours, p=0.034). The BNP-driven strategy increased the number of ventilator-free days but did not change length of stay or mortality. The effect on weaning time was strongest in patients with left ventricular systolic dysfunction. The two strategies did not differ significantly regarding electrolyte imbalance, renal failure, or shock. CONCLUSIONS: Our results suggest that a BNP-driven fluid management strategy decreases the duration of weaning without increasing adverse events, especially in patients with left ventricular systolic dysfunction.
Authors:
Armand Mekontso Dessap; Ferran Roche-Campo; Achille Kouatchet; Vinko Tomicic; Gaetan Beduneau; Romain Sonneville; Belen Cabello; Samir Jaber; Elie Azoulay; Diego Castanares-Zapatero; Jerome Devaquet; François Lellouche; Sandrine Katsahian; Laurent Brochard
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-20
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  -     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Service de Réanimation Médicale, Hopital Henri Mondor, Creteil, France.
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