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>Journals >Medicina Crítica >Year 2018, Issue 3


Torres GE, Mendoza PE, Mendoza RM
Index asynchrony/brain natriuretic peptide as a predictor of successful extubation in patients with chest trauma
Rev Asoc Mex Med Crit y Ter Int 2018; 32 (3)

Language: Español
References: 28
Page: 121-125
PDF: 161.95 Kb.


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ABSTRACT

Background: Chest trauma (CT) requires specific mechanical ventilation (MV) strategies; weaning is a complex situation. Ventilatory asynchrony (VA) implies an increased morbimortality, not described in the Mexican population.
Aim: To correlate the index of asynchrony (IA)/brain natriuretic peptide (BNP), (IABNP), with the result of extubation in patients with chest trauma.
Material and methods: A longitudinal study was done in intensive care units (ICU), 30 patients were included; the following variables were evaluated: demographics, type of trauma, IA, BNP before (BNP1) and after (BNP2) extubation, as well as IA/BNP as a scale to predict extubation. Endpoint: success or failure of the extubation (reintubation in next 48 hours).
Results: The study population was 96.7% masculine, 3.3% female; age: 34.4 ± 11.2 years. Successful withdrawal of MV was 70%. Type of trauma was pneumo/hemothorax 40%, hemothorax 16.7%, pneumothorax 10%, flail chest/pulmonary contusion 10%, other types 23.3%. BPN1: 44.2 ± 23.2 pg/dL, BNP2: 67 ± 49 pg/dL, IA: 13 ± 2%, IA/BNP: 0.28 ± 0.15, rapid surface respiration index (IVRS): 83.2 ± 13.1, maximum inspiration pressure (MIP): -24.2 ± 3.07, P 0.1-3.9 ± 0.7. Pearson correlation for IA and BNP1 was r = 0.71, the determination index: r2= 0.50, with significance p ‹ 0.001, confidence interval (CI) 95%; for AI and BNP2: r = 0.83, r2 = 0.68, p ‹ 0.001, CI 95%. Spearman correlation for IA/BNP and failure: r = 0.62, and determination index: r2 = 0.39, with significance p ‹ 0.001, CI 95%; for RSSR and failure: r = 0.31, r2 = 0.09, with p ‹ 0.094, CI 95%. IA/BNP ‹ 0.14 was related with failure at extubation.
Conclusions: IA/BNP ‹ 0.14 was a predictive marker for failure of weaning MV in the first 48 hours compared with the traditional RSRR, which was not statistically significant.


Key words: Asynchrony, BNP, extubation, chest trauma, mechanical ventilation.


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