Related Experiment Video
Updated: May 18, 2026
07:59
Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
Published on: July 28, 2018
Natriuretic peptide-driven fluid management during ventilator weaning: a randomized controlled trial
Armand Mekontso Dessap1, Ferran Roche-Campo, Achille Kouatchet
1Assistance Publique-Hoˆpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Henri Mondor, Service de Re´animation Me´dicale, Cre´teil, France. armand.dessap@hmn.aphp.fr
American Journal of Respiratory and Critical Care Medicine
|September 22, 2012
Summary
Fluid overload complicates mechanical ventilation weaning. A strategy using B-type natriuretic peptide (BNP) levels for fluid management significantly shortened weaning duration without increasing adverse events, particularly in patients with heart dysfunction.
Area of Science:
- Critical Care Medicine
- Cardiology
- Pulmonology
Background:
- Difficult weaning from mechanical ventilation is often linked to fluid overload.
- B-type natriuretic peptide (BNP) shows promise in predicting and detecting cardiovascular-related weaning failure.
Purpose of the Study:
- To compare fluid management guided by daily BNP levels versus empirical physician-directed therapy for improving ventilator weaning outcomes.
Main Methods:
- A randomized controlled multicenter study involving 304 patients.
- Patients were assigned to either a BNP-driven or physician-driven fluid management strategy.
- A standardized computer-driven weaning system was used for all participants.
Main Results:
- The BNP-driven group achieved a significantly shorter time to successful extubation (42.4 vs. 58.6 hours).
- BNP-guided fluid management resulted in a more negative fluid balance and increased ventilator-free days.
- No significant differences were observed in length of stay, mortality, electrolyte imbalance, renal failure, or shock between groups.
Conclusions:
- BNP-driven fluid management effectively reduces mechanical ventilation weaning duration.
- This strategy is particularly beneficial for patients with left ventricular systolic dysfunction.
- The approach appears safe, not increasing adverse events during the weaning process.
Related Concept Videos
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive positive-pressure ventilation (NIPPV), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP) are essential methods in respiratory care. These ventilation techniques offer unique benefits for patients with various respiratory conditions, providing adequate support without requiring intubation. Let's explore how each method is crucial in improving patient outcomes and enhancing respiratory therapy.
Noninvasive Positive-Pressure Ventilation (NIPPV)
Noninvasive Positive-Pressure Ventilation (NIPPV)
01:28Mitral Regurgitation IV: Nursing Management
Mitral regurgitation (MR) is a condition where the mitral valve does not close properly, leading to the backward flow of blood from the left ventricle into the left atrium during systole. This condition can arise from various causes, including rheumatic fever, infective endocarditis, or degenerative valve disease. Effective nursing management is crucial to optimizing patient outcomes and involves comprehensive assessment and targeted interventions.Comprehensive Patient AssessmentA detailed...
01:30Pneumonia V: Nursing management and Prevention
Nursing management of pneumonia involves promoting airway patency, facilitating rest and conserving energy, encouraging fluid intake, maintaining nutrition, and educating patients.
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
01:30Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
01:22Acute Kidney Injury VI: Nursing Management
Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
01:29Acute Respiratory Failure-V
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...