Introduction Predicting successful liberation from mechanical ventilation (MV) among critically ill patients receiving MV can be challenging. The current parameters used to predict successful extubation have shown variable predictive value. Brain natriuretic peptide (BNP) has been proposed as a novel biomarker to help guide decision-making in readiness for liberation of MV following a spontaneous breathing trial (SBT). Current evidence on the predictive ability of BNP has been uncertain, and BNP has not been integrated into clinical practice guidelines.
Methods and analysis We will perform a systematic review and meta-analysis to evaluate the value of BNP during SBT to predict success of liberation from MV. A search strategy will be developed in collaboration with a research librarian, and electronic databases (MEDLINE, EMBASE, Cochrane Library, Web of Science) and additional sources will be searched. Search themes will include: (1) BNP and (2) weaning, extubation and/or liberation from MV. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. The primary outcome will be liberation from MV; secondary outcomes will include time to reintubation, mortality, MV duration, total and postextubation intensive care unit (ICU) stay, hospitalisation duration, tracheostomy rate, ICU-acquired weakness rate and ventilator-free days. Primary statistical analysis will include predictive value of BNP by receiver operating characteristic curve, sensitivity/specificity and likelihood ratios for combination of BNP and SBT parameters for failure of liberation from MV. Secondary statistical analysis will be performed on individual and combinations of extracted metrics.
Ethics and dissemination Our review will add knowledge by mapping the current body of evidence on the value of BNP testing for prediction of successful liberation from MV, and describe knowledge gaps and research priorities. Our findings will be disseminated through peer-reviewed publication, presentation at a scientific congress, through regional/national organisations and social media. Research ethics approval is not required.
PROSPERO registration number CRD42018087474.
- natriuretic peptide
- ventilator weaning
- intensive care
- critical care
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Patient consent for publication Not required.
Contributors JD and JW were responsible for the preparation of the protocol and manuscript preparation. SMB, JS, JD and JW were responsible for finalising the protocol, statistical methods and completion of the final manuscript. RF developed the search strategy and conducted the search in consultation with JD, JW and SMB. MS provided support for methodology. BV provided support for statistical analysis. SMB conceived the project, and all authors provided critical revision of the protocol and final manuscript. SMB will guarantee the content of the review. All Authors read and approved the final manuscript.
Funding SMB is supported by a Canada Research Chair in Critical Care Nephrology. The project was supported by the Alberta Strategy for Patient Oriented Research (SPOR) SUPPORT Unit—Knowledge Translation Platform.
Competing interests None declared.
Ethics approval Data for this review will be sourced from available published and unpublished studies, if applicable. As such, no patient-specific primary data will be collected, and formal health research ethics approval is not required.
Provenance and peer review Not commissioned; externally peer reviewed.
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