Serum levels of N–terminal proB–type natriuretic peptide in mechanically ventilated critically ill patients – relation to tidal volume size and development of acute respiratory distress syndrome

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Serum levels of N–terminal proB–type natriuretic peptide (NT–proBNP) are elevated in patients acute respiratory distress syndrome (ARDS). Recent studies showed a lower incidence of acute cor pulmonale in ARDS patients ventilated with lower tidal volumes. Consequently, serum levels of NT–proBNP may be lower in these patients.

We investigated the relation between serum levels of NT–proBNP and tidal volumes in critically ill patients without ARDS at the onset of mechanical ventilation.

Methods

Secondary analysis of a randomized controlled trial of lower versus conventional tidal volumes in patients without ARDS. NT–pro BNP were measured in stored serum samples. Serial serum levels of NT–pro BNP were analyzed controlling for acute kidney injury, cumulative fluid balance and presence of brain injury. The primary outcome was the effect of tidal volume size on serum levels of NT–proBNP. Secondary outcome was the association with development of ARDS.

Results

Samples from 150 patients were analyzed. No relation was found between serum levels of NT–pro BNP and tidal volume size. However, NT-proBNP levels were increasing in patients who developed ARDS. In addition, higher levels were observed in patients with acute kidney injury, and in patients with a more positive cumulative fluid balance.

Conclusion

Serum levels of NT–proBNP are independent of tidal volume size, but are increasing in patients who develop ARDS.

Related collections

Most cited references 17

Record: found
Abstract: not found
Article: not found

An expanded definition of the adult respiratory distress syndrome.

J F Murray, M Matthay, J Luce … (1988)

0 comments Cited 363 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial

Rogier Determann, Annick ANM Royakkers, Esther Wolthuis … (2010)

Introduction Recent cohort studies have identified the use of large tidal volumes as a major risk factor for development of lung injury in mechanically ventilated patients without acute lung injury (ALI). We compared the effect of conventional with lower tidal volumes on pulmonary inflammation and development of lung injury in critically ill patients without ALI at the onset of mechanical ventilation. Methods We performed a randomized controlled nonblinded preventive trial comparing mechanical ventilation with tidal volumes of 10 ml versus 6 ml per kilogram of predicted body weight in critically ill patients without ALI at the onset of mechanical ventilation. The primary end point was cytokine levels in bronchoalveolar lavage fluid and plasma during mechanical ventilation. The secondary end point was the development of lung injury, as determined by consensus criteria for ALI, duration of mechanical ventilation, and mortality. Results One hundred fifty patients (74 conventional versus 76 lower tidal volume) were enrolled and analyzed. No differences were observed in lavage fluid cytokine levels at baseline between the randomization groups. Plasma interleukin-6 (IL-6) levels decreased significantly more strongly in the lower-tidal-volume group ((from 51 (20 to 182) ng/ml to 11 (5 to 20) ng/ml versus 50 (21 to 122) ng/ml to 21 (20 to 77) ng/ml; P = 0.01)). The trial was stopped prematurely for safety reasons because the development of lung injury was higher in the conventional tidal-volume group as compared with the lower tidal-volume group (13.5% versus 2.6%; P = 0.01). Univariate analysis showed statistical relations between baseline lung-injury score, randomization group, level of positive end-expiratory pressure (PEEP), the number of transfused blood products, the presence of a risk factor for ALI, and baseline IL-6 lavage fluid levels and the development of lung injury. Multivariate analysis revealed the randomization group and the level of PEEP as independent predictors of the development of lung injury. Conclusions Mechanical ventilation with conventional tidal volumes is associated with sustained cytokine production, as measured in plasma. Our data suggest that mechanical ventilation with conventional tidal volumes contributes to the development of lung injury in patients without ALI at the onset of mechanical ventilation. Trial registration ISRCTN82533884

0 comments Cited 127 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis.

David Page, S Prin, F. Jardin … (2001)

The incidence of acute cor pulmonale (ACP), a frequent and usually lethal complication of acute respiratory distress syndrome (ARDS) during traditional respiratory support, has never been re-evaluated since protective ventilation gained acceptance. We performed a longitudinal transesophageal echocardiographic (TEE) study to determine whether this incidence, and its severe implications for prognosis, might have changed in our unit as we altered respiratory strategy. Prospective open clinical study. Medical intensive care unit of a university hospital. Seventy-five consecutive ARDS patients given respiratory support with airway pressure limitation (plateau pressure 0.6 associated with septal dyskinesia in the short axis during TEE examination. Normal right ventricular function was present in 56 patients, whereas right ventricular dysfunction was observed in 19 patients after 2 days of respiratory support. ACP was associated with pulmonary artery hypertension, increased heart rate, and decreased stroke index. Significant impairment of left ventricular diastolic function was also seen. All echo-Doppler abnormalities were reversible in patients who recovered, and the mortality rate was the same in both groups (32%). However, ACP patients who recovered required a longer period of respiratory support. A multivariate analysis individualized Paco2 level as the sole factor independently associated with ACP, suggesting that ACP development in ARDS is influenced by the severity of lung damage and/or the respiratory strategy. Evaluation of right ventricular function by TEE in a group of 75 ARDS patients submitted to protective ventilation revealed the persistence of a 25% incidence of ACP, resulting in detrimental hemodynamic consequences associated with tachycardia. However, ACP was reversible in patients who recovered and did not increase mortality.

0 comments Cited 104 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Rogier M Determann

Annick ANM Royakkers

Jacqueline Schaefers

Anita M de Boer

Jan M Binnekade

Jan P van Straalen

Marcus J Schultz

Journal

Journal ID (nlm-ta): BMC Pulm Med

Journal ID (iso-abbrev): BMC Pulm Med

Title: BMC Pulmonary Medicine

Publisher: BioMed Central

ISSN (Electronic): 1471-2466

Publication date Collection: 2013

Publication date (Electronic): 9 July 2013

Volume: 13

Page: 42

Affiliations

[1 ]Department of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands

[2 ]Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

[3 ]Department of Internal Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

[4 ]Laboratory of Clinical Chemistry (LAKC), Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

[5 ]Department of Anesthesiology, Tergooi Hospitals, Blaricum, The Netherlands

Article

Publisher ID: 1471-2466-13-42

DOI: 10.1186/1471-2466-13-42

PMC ID: 3717013

PubMed ID: 23837838

SO-VID: 95d99aff-81d8-4e5d-b837-5c4f0e1d8b91

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Serum levels of N–terminal proB–type natriuretic peptide in mechanically ventilated critically ill patients – relation to tidal volume size and development of acute respiratory distress syndrome

Read this article at

Abstract

Background

Methods

Results

Conclusion

Related collections

Inflamed lung in vitro co-culture models

Most cited references 17

An expanded definition of the adult respiratory distress syndrome.

Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial

Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis.

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Comments

Comment on this article

Similar content 243

Cited by 6

Most referenced authors 452