The predictive value of brain natriuretic peptide or N-terminal pro-brain natriuretic peptide for weaning outcome in mechanical ventilation patients: Evidence from SROC.

Objective: Mechanical ventilation is an important treatment for critically ill patients. Physicians generally perform a spontaneous breathing trial (SBT) to determine whether the patients can be weaned from mechanical ventilation, but almost 17% of the patients who pass the SBT still require respiratory support. Cardiac dysfunction is an important cause of weaning failure. The use of brain natriuretic peptide or N-terminal pro-BNP is a simple method to assess cardiac function. We performed a systematic review of investigations of brain natriuretic peptide or N-terminal pro-BNP as predictors of weaning from mechanical ventilation.

Data sources: PubMed (1950 to December 2020), Cochrane, and Embase (1974 to December 2020), and some Chinese databases for additional articles (China Biology Medicine (CBM), China Science and Technology Journal Database (CSTJ), and Wanfang Data and China National Knowledge Infrastructure (CNKI)).

Study selection: We systematically searched observation studies investigating the predictive value of brain natriuretic peptide or N-terminal pro-brain natriuretic peptide in weaning outcome of patients with mechanical ventilation.

Data extraction: Two independent reviewers extracted data. The differences are resolved through consultation.

Data synthesis: We included 18 articles with 1416 patients and extracted six index tests with pooled sensitivity and specificity for each index test. For the BNP change rate predicting weaning success, the pooled sensitivity was 89% (83%-94%) and the pooled specificity was 82% (72%-89%) with the highest pooled AUC of 0.9511.

Conclusions: The brain natriuretic peptide change rate is a reliable predictor of weaning outcome from mechanical ventilation.