Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study



To assess the cardiac consequences of successful respiratory weaning using the variations of circulating B-type and atrial natriuretic peptides (BNP, ANP) and Doppler mitral flow.


A prospective preliminary observational study.


A 14-bed medical ICU in a French university hospital.


Thirty-one patients undergoing a spontaneous breathing trial on a T-tube.


Circulating BNP and ANP levels and Doppler-derived E/A ratio and deceleration time of the E wave were measured before and 1 h after disconnection.


BNP levels increased from 299 pg/ml (range 56–1079) to 412 pg/ml (147–1324) (p = 0.02) in patients with systolic left ventricular dysfunction, decreased from 98 pg/ml (25–337) to 45 pg/ml (38–180) (p = 0.04) in patients with right ventricular dilation and remained unchanged in patients with neither of these cardiac abnormalities. Overall ANP levels increased from 33 pg/ml to 67 pg/ml (p < 0.001) regardless of ventricular function. The E/A ratio increased from 0.91 (0.66–3.56) to 1.17 (0.5–4.76), (p = 0.01), after disconnection, whereas deceleration time of E wave decreasedfrom 185 ms (120–280) to 160 ms (70–206) (p = 0.02).


During successful weaning from mechanical ventilation ANP levels increase in all patients whereas changes in BNP levels depend on underlying cardiac function. Changes in Doppler mitral flow indexes following ventilator disconnection suggest an increase in left-ventricular filling pressure.

This is a preview of subscription content, log in to check access.


  1. 1.

    Lemaire F, Teboul JL, Cinotti L, Giotto G, Abrouk F, Steg G, Macquin-Mavier I, Zapol WM (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171–179

  2. 2.

    Jubran A, Mathru M, Dries D, Tobin MJ (1998) Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 158:1763–176

  3. 3.

    Richard C, Teboul JL, Archambaud F, Hebert JL, Michaut P, Auzepy P (1994) Left ventricular function during weaning of patients with chronic obstructive pulmonary disease. Intensive Care Med 20:181–186

  4. 4.

    Cauliez B, Berthe MC, Lavoinne A (2005)Le BNP: aspects physiologiques, biologiques et cliniques. Ann Biol Clin 63:15–25

  5. 5.

    Dokainish H, Zoghbi WA, Lakkis NM, Quinones MA, Nagueh SF (2004) Comparative accuracy of B-type natriuretic peptide and tissue Doppler echocardiography in the diagnosis of congestive heart failure. Am J Cardiol 93:1130–1135

  6. 6.

    Yoshimura M, Yasue H, Okumura K, Ogawa H, Jougasaki M, Mukoyama M, Nakao K, Imura H (1993) Different secretion patterns of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure. Circulation 87:464–469

  7. 7.

    Logeart D, Saudubray C, Beyne P, Thabut G, Ennezat PV, Chavelas C, Zanker C, Bouvier E, Cohen Solal A (2002) Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Cardiol 40:1794–1800

  8. 8.

    Boussuges A, Blanc P, Molenat F, Burnet H, Habib G, Sainty JM (2002). Evaluation of left ventricular filling pressure by transthoracic Doppler echocardiography in the intensive care unit. Crit Care Med 30:362–367

  9. 9.

    Richard C, Beydon L, Cantagrel S, Cuvelier A, Fauroux B, Garo B, Holzapfel L, Lesieur O, Levraut J, Maury E, Polet C, Roche N, Roesler J (2001) Sevrage de la ventilation mécanique (à l'exclusion du nouveau-né et de la salle de réveil). Réanimation 10:699–705

  10. 10.

    Magga J, Vuolteenaho O, Tokola H, Marttila M, Ruskoaho H (1997) Involvement of transcriptional and posttranscriptional mechanisms in cardiac overload-induced increase of B-type natriuretic peptide gene expression. Circ Res 81:694–702

  11. 11.

    Thabut G, Logeart D (2003) Utility of brain natriuretic peptide to predict right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism. Circulation 108:94–95

  12. 12.

    Kucher N, Printzen G, Goldhaber SZ (2003) Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation 107:2545–2547

  13. 13.

    Jardin F (2004) Cyclic changes in arterial pressure during mechanical ventilation. Intensive Care Med 30:1047–1050

  14. 14.

    Jardin F, Vieillard-Baron A (2003) Right ventricular function and positive pressure ventilation in clinical practice: from hemodynamic subsets to respirator settings. Intensive Care Med 29:1426–1434

  15. 15.

    Asada J, Tsuji H, Iwasaka T, Thomas JD, Lauer MS (2004) Usefulness of plasma brain natriuretic peptide levels in predicting dobutamine-induced myocardial ischemia. Am J Cardiol 93:702–704

  16. 16.

    Sabatine MS. Morrow DA, de Lemos JA, Omland T, Desai MY, Tanasijevic M, Hall C, McCabe CH, Braunwald E (2004) Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia. J Am Coll Cardiol 44:1988–1995

Download references

Author information

Correspondence to Eric Maury.

Additional information

No author has any conflict of interest in this study.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ait-Oufella, H., Tharaux, P., Baudel, J. et al. Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study. Intensive Care Med 33, 1183–1186 (2007).

Download citation


  • Weaning
  • Mechanical ventilation
  • Brain natriuretic peptide
  • Atrial natriuretic peptide
  • Echocardiography
  • Mitral Doppler