• Thiago Martins Lara, Ludhmila Abrahao Hajjar, Juliano Pinheiro de Almeida, Julia Tizue Fukushima, Carmem Silvia Valente Barbas, Adriano Rogerio Baldacin Rodrigues, Emilia Nozawa, Maria Ignes Zanetti Feltrim, Elisangela Almeida, Vera Coimbra, Eduardo Osawa, Rafael de Moraes Ianotti, Alcino Costa Leme, Fabio Biscegli Jatene, Jose Otavio Costa Auler-Jr, and Filomena Regina Barbosa Gomes Galas.
• Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Heart Institute (InCor), Surgical Intensive Care Unit and Department of Anesthesiology, São Paulo/SP, Brazil. thiagomlara@hotmail.com
• Clinics (Sao Paulo). 2013 Jan 1;68(1):33-8.

ObjectiveThe failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery.MethodsWe conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h.ResultsOf the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation.ConclusionsA high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period.

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