Changes in B-type natriuretic peptide and related hemodynamic parameters following a fluid challenge in critically ill patients with severe sepsis or septic shock

Omar, Shahed, Ali, Ahmad, Atiya, Yahya, Mathivha, Rudo Lufuno and Dulhunty, Joel M. (2017) Changes in B-type natriuretic peptide and related hemodynamic parameters following a fluid challenge in critically ill patients with severe sepsis or septic shock. Indian Journal of Critical Care Medicine, 21 3: 117-121. doi:10.4103/ijccm.IJCCM-318-16


Author Omar, Shahed
Ali, Ahmad
Atiya, Yahya
Mathivha, Rudo Lufuno
Dulhunty, Joel M.
Title Changes in B-type natriuretic peptide and related hemodynamic parameters following a fluid challenge in critically ill patients with severe sepsis or septic shock
Journal name Indian Journal of Critical Care Medicine   Check publisher's open access policy
ISSN 1998-359X
0972-5229
Publication date 2017-03-01
Sub-type Article (original research)
DOI 10.4103/ijccm.IJCCM-318-16
Open Access Status DOI
Volume 21
Issue 3
Start page 117
End page 121
Total pages 5
Place of publication Mumbai, Maharastra, India
Publisher Medknow Publications and Media
Collection year 2018
Language eng
Formatted abstract
Context: Severe sepsis or septic shock.

Aims: The aim of this study is to examine the effect of a fluid challenge on the B-type natriuretic peptide (BNP) and the hemodynamic state.

Settings and Design: This observational study was conducted in an intensivist-led academic, mixed medical-surgical Intensive Care Unit.

Subjects and Methods: Focused transthoracic echocardiogram, plasma BNP, and hemodynamic measurements were recorded at baseline and following a 500 ml fluid challenge in thirty patients. Independent predictors of the percentage (%) change in stroke volume (SV) were sought. Next, these independent predictors were assessed for a relationship with the percentage change in BNP.

Statistical Analysis Used: Multiple linear regressions, Wilcoxon rank-sum test, t-test, and Pearson's correlation were used. Data analysis was carried out using SAS. The 5% significance level was used.

Results: Using a multiple regression models, the percentage increase in SV was independently predicted by the percentage increase in mean arterial pressure, left ventricular end-diastolic volume/dimension (LVEDV/LVEDd), ejection fraction, and a decrease in Acute Physiology and Chronic Health Evaluation II score (P < 0.0001). Preload, measured using LVEDV1 (before the fluid challenge) was significantly larger in the fluid nonresponders (%SV increase <15%) vs. The responders (%SV increase ≥15%). Finally, the percentage change in BNP was positively correlated with left ventricular size at end diastole LVEDd, r = 0.4, P < 0.035).

Conclusions: An increase in BNP soon after a fluid challenge may have some predictive utility of a large LVEDd, which in turn can be used to independently predict the SV response to a fluid challenge.
Keyword B-type natriuretic peptide
Critically ill
Fluid challenge
Hemodynamic
Intensive care
Sepsis
Severe sepsis
Shock
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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