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Review
. 2024 May 30;13(11):3242.
doi: 10.3390/jcm13113242.

The Value of Ischemic Cardiac Biomarkers to Predict Spontaneous Breathing Trial or Extubation Failure: A Systematic Review

Carline N L Groenland  1 , Maud A Blijleven  1 , Imane Ramzi  1 , Eric A Dubois  1   2 , Leo Heunks  1   3 , Henrik Endeman  1 , Evert-Jan Wils  4 , Vivan J M Baggen  1   2
Affiliations
Review

The Value of Ischemic Cardiac Biomarkers to Predict Spontaneous Breathing Trial or Extubation Failure: A Systematic Review

Carline N L Groenland et al. J Clin Med. .

Abstract

Background: It is unclear whether other cardiac biomarkers than NT-proBNP can be useful in the risk stratification of patients weaning from mechanical ventilation. The aim of this study is to summarize the role of ischemic cardiac biomarkers in predicting spontaneous breathing trial (SBT) or extubation failure. Methods: We systematically searched Embase, MEDLINE, Web of Science, and Cochrane Central for studies published before January 2024 that reported the association between ischemic cardiac biomarkers and SBT or extubation failure. Data were extracted using a standardized form and methodological assessment was performed using the QUIPS tool. Results: Seven observational studies investigating four ischemic cardiac biomarkers (Troponin-T, Troponin-I, CK-MB, Myoglobin) were included. One study reported a higher peak Troponin-I in patients with extubation failure compared to extubation success (50 ng/L [IQR, 20-215] versus 30 ng/L [IQR, 10-86], p = 0.01). A second study found that Troponin-I measured before the SBT was higher in patients with SBT failure in comparison to patients with SBT success (100 ± 80 ng/L versus 70 ± 130 ng/L, p = 0.03). A third study reported a higher CK-MB measured at the end of the SBT in patients with weaning failure (SBT or extubation failure) in comparison to weaning success (8.77 ± 20.5 ng/mL versus 1.52 ± 1.42 ng/mL, p = 0.047). Troponin-T and Myoglobin as well as Troponin-I and CK-MB measured at other time points were not found to be related to SBT or extubation failure. However, most studies were underpowered and with high risk of bias. Conclusions: The association with SBT or extubation failure is limited for Troponin-I and CK-MB and appears absent for Troponin-T and Myoglobin, but available studies are hampered by significant methodological drawbacks. To more definitively determine the role of ischemic cardiac biomarkers, future studies should prioritize larger sample sizes, including patients at risk of cardiac disease, using stringent SBTs and structured timing of laboratory measurements before and after SBT.

Keywords: SBT failure; extubation failure; intensive care; ischemic cardiac biomarkers; ventilator weaning.

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Conflict of interest statement

H.E. has received unrestricted research grants from ZonMW (The Netherlands), Fisher and Paykel Healthcare (Auckland, New Zealand), Roche Diagnostics International Ltd. (Basel, Switzerland) and Ventinova Medical B.V. (Eindhoven, The Netherlands) and the speakers fee from Getinge (Sweden). L.H. has received the speakers fee from Getinge (Sweden), research support from Liberate Medical (Crestwood, Kentucky), ZonMw (The Netherlands) and the European Respiratory Society, and personal fees from the American Thoracic Society. All other authors declared that they have no competing interests. The other authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of the study selection process according to the PRISMA statement [22].
Figure 2
Figure 2
Summary of risk of bias of the included studies.
See this image and copyright information in PMC

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