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Indian Journal of Critical Care Medicine
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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

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:
Dr. Shahed Omar
32, Road Number 3, Victory Park, Johannesburg 2195
South Africa
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijccm.IJCCM_318_16

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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.


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Online since 7th April '04
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