Use of B‐type natriuretic peptide in the management of hypoxaemic respiratory failure
Open Access
- 18 February 2011
- journal article
- research article
- Published by Wiley in European Journal of Heart Failure
- Vol. 13 (2), 154-162
- https://doi.org/10.1093/eurjhf/hfq188
Abstract
Aims Evaluation and management of patients with hypoxaemic respiratory failure in the intensive care unit (ICU) are difficult. The use of B‐type natriuretic peptide (BNP), a quantitative marker of cardiac stress and heart failure (HF), may be helpful. The purpose of this study is to describe the prevalence of causative disorders of hypoxaemic respiratory failure in the ICU and to determine the impact of a BNP‐guided diagnostic strategy. Methods and results This prospective, multi‐centre, randomized, single‐blind, controlled trial included 314 ICU patients with hypoxaemic respiratory failure: 159 patients were randomly assigned to a diagnostic strategy involving the measurement of BNP and 155 were assessed in a standard manner. The time to discharge and the total cost of treatment were the primary endpoints. Hypoxaemic respiratory failure was multi‐causal in 27% of the patients. Heart failure was the most common diagnosis in both groups. The use of BNP levels, in conjunction with other clinical information, significantly increased the detection of HF in combination with an additional diagnosis (32 vs. 16%, P = 0.001) and also increased the application of HF‐specific medical therapy (nitrates: 32 vs. 23%, P < 0.05 and diuretics: 65 vs. 50%, P < 0.01). Time to discharge (median, 13 vs.14 days, P = 0.50) and total cost of treatment (median, US‐$6190 vs. 7155, P = 0.24) were comparable in both groups. Conclusion Hypoxaemic respiratory failure in the ICU is often a multi‐causal disorder. The use of BNP increased the detection of HF, but did not significantly improve patient management as quantified by time to discharge or treatment cost. ClinicalTrials.gov Identifier: NCT00130559.Keywords
This publication has 31 references indexed in Scilit:
- B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency DepartmentCirculation: Heart Failure, 2010
- Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort studyCritical Care, 2008
- Statistics in Medicine — Reporting of Subgroup Analyses in Clinical TrialsNew England Journal of Medicine, 2007
- Costs of adverse events in intensive care units*Critical Care Medicine, 2007
- Medical and Economic Long-term Effects of B-Type Natriuretic Peptide Testing in Patients with Acute DyspneaClinical Chemistry, 2007
- Diagnostic and Prognostic Utility of Brain Natriuretic Peptide in Subjects Admitted to the ICU With Hypoxic Respiratory Failure Due to Noncardiogenic and Cardiogenic Pulmonary EdemaChest, 2007
- Antibiotic Treatment of Exacerbations of COPD: A Randomized, Controlled Trial Comparing Procalcitonin-Guidance With Standard TherapyChest, 2007
- Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: results from the Breathing Not Properly (BNP) multinational studyAmerican Heart Journal, 2004
- Preliminary Evaluation of the AxSYM B-Type Natriuretic Peptide (BNP) Assay and Comparison with the ADVIA Centaur BNP AssayClinical Chemistry, 2004
- APACHE IICritical Care Medicine, 1985