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Brain-type natriuretic peptide and right ventricular end-diastolic volume index measurements are imprecise estimates of circulating blood volume in critically ill subjects.
J Trauma Acute Care Surg. 2013 Nov; 75(5):813-8.JT

Abstract

BACKGROUND

Surrogate indicators have often been used to estimate intravascular volume to guide fluid management. Brain-type natriuretic peptide (BNP) has been used as a noninvasive adjunct in the diagnosis of fluid overload and as a marker of response to therapy, especially in individuals with congestive heart failure. Similarly, right ventricular end-diastolic volume index (RVEDVI) measurements represent another parameter used to guide fluid resuscitation. The aim of this study was to evaluate whether BNP and RVEDVI are clinically valuable parameters that can distinguish among hypovolemia, euvolemia, and hypervolemia, as measured by blood volume (BV) analysis in critically ill surgical subjects.

METHODS

This observational study was part of a prospective, randomized controlled trial. Subjects with pulmonary artery catheters for the treatment of traumatic injuries, severe sepsis/septic shock, cardiovascular collapse, adult respiratory distress syndrome, and postsurgical care were studied. Circulating BV was measured by a radioisotope dilution technique using the BVA-100 Analyzer (Daxor Corporation, New York, NY) within the first 24 hours of acute resuscitation. BV results were reported as percent deviation from the patient's ideal BV based on height and percent deviation from optimum weight. Hypovolemia was defined as less than 0%, euvolemia was defined as 0% to +16%, and hypervolemia was defined as greater than +16% deviation from ideal BV. RVEDVI was measured by continuous cardiac output pulmonary artery catheters (Edwards Lifesciences, Irvine, CA). BNP and RVEDVI measurements obtained with BV analysis were evaluated with Fisher's exact test and regression analysis.

RESULTS

In 81 subjects, there was no difference in BV status between those with BNP of 500 pg/mL or greater and BNP of less than 500 pg/mL (p = 0.82) or in those with RVEDVI of 140 mL/m or greater and RVEDVI of less than 140 mL/m (p = 0.43). No linear relationship existed between BV and these parameters.

CONCLUSION

In critically ill surgical patients, BNP and RVEDVI were not associated with intravascular volume status, although they may be useful as indices that reflect increased cardiac preload.

LEVEL OF EVIDENCE

Diagnostic study, level III.

Authors+Show Affiliations

From the Department of Surgery, John A. Burns School of Medicine, University of Hawaii; and The Queen's Medical Center, Honolulu, Hawaii.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24158199

Citation

Takahashi, Edwin A., et al. "Brain-type Natriuretic Peptide and Right Ventricular End-diastolic Volume Index Measurements Are Imprecise Estimates of Circulating Blood Volume in Critically Ill Subjects." The Journal of Trauma and Acute Care Surgery, vol. 75, no. 5, 2013, pp. 813-8.
Takahashi EA, Moran SE, Hayashi MS, et al. Brain-type natriuretic peptide and right ventricular end-diastolic volume index measurements are imprecise estimates of circulating blood volume in critically ill subjects. J Trauma Acute Care Surg. 2013;75(5):813-8.
Takahashi, E. A., Moran, S. E., Hayashi, M. S., Inouye, D. S., Takanishi, D. M., & Yu, M. (2013). Brain-type natriuretic peptide and right ventricular end-diastolic volume index measurements are imprecise estimates of circulating blood volume in critically ill subjects. The Journal of Trauma and Acute Care Surgery, 75(5), 813-8. https://doi.org/10.1097/TA.0b013e3182a85f3a
Takahashi EA, et al. Brain-type Natriuretic Peptide and Right Ventricular End-diastolic Volume Index Measurements Are Imprecise Estimates of Circulating Blood Volume in Critically Ill Subjects. J Trauma Acute Care Surg. 2013;75(5):813-8. PubMed PMID: 24158199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Brain-type natriuretic peptide and right ventricular end-diastolic volume index measurements are imprecise estimates of circulating blood volume in critically ill subjects. AU - Takahashi,Edwin A, AU - Moran,Sharon E, AU - Hayashi,Michael S, AU - Inouye,David S, AU - Takanishi,Danny M,Jr AU - Yu,Mihae, PY - 2013/10/26/entrez PY - 2013/10/26/pubmed PY - 2014/1/8/medline SP - 813 EP - 8 JF - The journal of trauma and acute care surgery JO - J Trauma Acute Care Surg VL - 75 IS - 5 N2 - BACKGROUND: Surrogate indicators have often been used to estimate intravascular volume to guide fluid management. Brain-type natriuretic peptide (BNP) has been used as a noninvasive adjunct in the diagnosis of fluid overload and as a marker of response to therapy, especially in individuals with congestive heart failure. Similarly, right ventricular end-diastolic volume index (RVEDVI) measurements represent another parameter used to guide fluid resuscitation. The aim of this study was to evaluate whether BNP and RVEDVI are clinically valuable parameters that can distinguish among hypovolemia, euvolemia, and hypervolemia, as measured by blood volume (BV) analysis in critically ill surgical subjects. METHODS: This observational study was part of a prospective, randomized controlled trial. Subjects with pulmonary artery catheters for the treatment of traumatic injuries, severe sepsis/septic shock, cardiovascular collapse, adult respiratory distress syndrome, and postsurgical care were studied. Circulating BV was measured by a radioisotope dilution technique using the BVA-100 Analyzer (Daxor Corporation, New York, NY) within the first 24 hours of acute resuscitation. BV results were reported as percent deviation from the patient's ideal BV based on height and percent deviation from optimum weight. Hypovolemia was defined as less than 0%, euvolemia was defined as 0% to +16%, and hypervolemia was defined as greater than +16% deviation from ideal BV. RVEDVI was measured by continuous cardiac output pulmonary artery catheters (Edwards Lifesciences, Irvine, CA). BNP and RVEDVI measurements obtained with BV analysis were evaluated with Fisher's exact test and regression analysis. RESULTS: In 81 subjects, there was no difference in BV status between those with BNP of 500 pg/mL or greater and BNP of less than 500 pg/mL (p = 0.82) or in those with RVEDVI of 140 mL/m or greater and RVEDVI of less than 140 mL/m (p = 0.43). No linear relationship existed between BV and these parameters. CONCLUSION: In critically ill surgical patients, BNP and RVEDVI were not associated with intravascular volume status, although they may be useful as indices that reflect increased cardiac preload. LEVEL OF EVIDENCE: Diagnostic study, level III. SN - 2163-0763 UR - https://www.unboundmedicine.com/medline/citation/24158199/Brain_type_natriuretic_peptide_and_right_ventricular_end_diastolic_volume_index_measurements_are_imprecise_estimates_of_circulating_blood_volume_in_critically_ill_subjects_ L2 - http://dx.doi.org/10.1097/TA.0b013e3182a85f3a DB - PRIME DP - Unbound Medicine ER -