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Year : 2017  |  Volume : 21  |  Issue : 3  |  Page : 117-121  

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

Shahed Omar1, Ahmad Ali1, Yahya Atiya1, Rudo Lufuno Mathivha1, Joel M Dulhunty2 
1 Division of Critical care, Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
2 Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, The Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia

Correspondence Address:
Shahed Omar
32, Road Number 3, Victory Park, Johannesburg 2195
South Africa

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.


How to cite this article:
Omar S, Ali A, Atiya Y, Mathivha RL, Dulhunty JM. 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 J Crit Care Med 2017;21:117-121


How to cite this URL:
Omar S, Ali A, Atiya Y, Mathivha RL, Dulhunty JM. 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 J Crit Care Med [serial online] 2017 [cited 2017 Mar 22 ];21:117-121
Available from: http://www.ijccm.org/article.asp?issn=0972-5229;year=2017;volume=21;issue=3;spage=117;epage=121;aulast=Omar;type=0