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

Rogier M Determann,Jan M Binnekade,Anita M De Boer,Annick Anm Royakkers,Marcus J Schultz,Jacqueline Schaefers,Jan P Van Straalen

doi:10.1186/1471-2466-13-42

Rogier M Determann, Jan M Binnekade + Show 5 more

Open Access

https://doi.org/10.1186/1471-2466-13-42

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Journal: BMC Pulmonary Medicine	Publication Date: Jul 9, 2013
Citations: 32	License type: CC BY 2.0

Affiliation: University of Amsterdam, Tergooi

Abstract

BackgroundSerum 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.MethodsSecondary 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.ResultsSamples 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.ConclusionSerum levels of NT–proBNP are independent of tidal volume size, but are increasing in patients who develop ARDS.

Highlights

Serum levels of N–terminal proB–type natriuretic peptide (NT–proBNP) are elevated in patients acute respiratory distress syndrome (ARDS)
We hypothesized that conventional tidal volumes may lead to increased pulmonary vascular resistance as the incidence or ARDS is higher compared to lower tidal volumes [11]. In this way, increased pulmonary vascular resistance may lead to increased stretching of the right ventricle and increased NT-proBNP levels. To investigate this possibility we studied the relation between tidal volumes and NT–proBNP levels
The purpose of this study was (a) to investigate whether serum levels of NT–proBNP are dependent on tidal volume size in patients without ARDS, and (b) serum levels of NT–proBNP to increase parallel to severity of lung injury, when controlling for acute kidney injury, cumulative fluid balance and presence of brain injury

Summary

Introduction

Serum levels of N–terminal proB–type natriuretic peptide (NT–proBNP) are elevated in patients acute respiratory distress syndrome (ARDS). 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. Both atelectasis and fibrosis may decrease pulmonary compliance in patients with acute respiratory distress syndrome (ARDS) [1]. The right ventricle secretes less NT–proBNP than the left ventricle [5,6] serum levels of NT– proBNP can be elevated in patients with an acute cor pulmonale due to ARDS [7,8]. NT–proBNP levels can be elevated due to kidney failure [9] and elevated levels are seen in patients with acute brain injury [10]

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