The Prognostic Value of Plasma Brain Natriuretic Peptide as a Predictor of Weaning Outcome from Mechanical Ventilation in Critically Ill Children

Background: Safe weaning from mechanical ventilation in children remains challenging. Conventional weaning indices often lack accuracy. B-type natriuretic peptide (BNP) may reflect cardiovascular stress during spontaneous breathing trials (SBTs) and provide prognostic value. This study aimed to evaluate the predictive value of BNP levels for weaning outcomes in critically ill pediatric patients. Methods: A prospective cohort study was conducted in the pediatric intensive care unit (PICU) on forty-two intubated children meeting SBT readiness. BNP was measured at SBT initiation (BNP I) and completion (BNP II). Clinical, laboratory, and outcome data were recorded. The primary endpoint was weaning outcome (success vs. failure, defined as failed SBT or reintubation ≤48 h). Results: BNP I independently predicted weaning failure (AOR 1.059; 95% CI 1.006–1.115; p=0.029). BNP I correlated with PICU stay duration (r=0.515, p<0.001). BNP II correlated positively with respiratory rate (r=0.329, p=0.033), pH (r=0.319, p=0.033), BNP I (r=0.445, p=0.003), and PICU stay (r=0.491, p<0.001), and negatively with GCS (r=−0.466, p=0.002).ROC analysis showed BNP I ≥892.7 pg/mL predicted weaning failure with AUC 0.962, sensitivity 90.9%, specificity 87.1%, PPV 71.4%, NPV 96.4% (p<0.001). BNP II ≥905.2 pg/mL also performed well (AUC 0.921, sensitivity 81.8%, specificity 87.1%, PPV 69.2%, NPV 93.1%, p<0.001). Survivors showed greater BNP reduction than non-survivors (6.13% vs. −0.39%, p<0.001). Conclusion: BNP, particularly baseline BNP I, could be an independent predictor of weaning failure in critically ill children. It outperformed conventional indices and was associated with prolonged PICU stay and mortality.