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Brain natriuretic peptide and left ventricular area variation with fluid challenge in septic shock: an echocardiographic study (preliminary results)

Introduction

Myocyte stretch is the main stimulus of brain natriuretic peptide (BNP) synthesis and release. During septic shock, important variations of volemia can occur and a correlation has been described between the cardiac index and the BNP level [1]. However, the relation between the echocardiographic left ventricule area and the BNP level has never been described. The aim of our study was to evaluate BNP and left ventricule area variations after an acute fluid loading in septic shock.

Methods

Mechanical ventilated patients with septic shock, and without anterior cardiac disease, were included in our study. A fluid challenge was performed with colloid (500 ml) in 30 minutes. A BNP blood sample was drawn before and 1 hour after fluid loading. The primary endpoint was BNP variation after fluid challenge. Median values (25–75th percentiles) were compared with the Wilcoxon test (P < 0.05). The end-diastolic left ventricule area was recorded before and 1 hour after fluid challenge. Linear regression of BNP variation and left ventricular area variation was determined and r2 was calculated.

Results

Eight patients (median age 68 years; six males/two females; SOFA score = 12) were enrolled in our study. The initial BNP level median increased from 695 (417–2,738) to 715 (478–2,596) μg/ml after a fluid loading (P = 0.7) (Figure 1).We did not find a statistically significant relationship between BNP variation and left ventricule area variation after fluid challenge (P = 0.13) (Figure 2).

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Figure 2
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Conclusion

There is no increase in BNP level in patients with septic shock after fluid challenge. To our knowledge, this preliminary study is the first to evaluate the relationship between BNP and left ventricule area variation in patient with septic shock. Although no statistical significance between left ventricule area variation and BNP variation after fluid challenge, there is a trend to correlation between these two parameters. More patients have to be included to confirm this result.

References

  1. 1.

    McLean AS: The effects of acute fluid loading on plasma B-type natriuretic peptide levels in a septic shock patient. Anesth Intensive Care 2005, 33: 528-530.

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Ghaddab, A., Quintard, H., Rami, L. et al. Brain natriuretic peptide and left ventricular area variation with fluid challenge in septic shock: an echocardiographic study (preliminary results). Crit Care 11, P454 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5614

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Keywords

  • Septic Shock
  • Cardiac Index
  • Wilcoxon Test
  • Brain Natriuretic Peptide
  • Echocardiographic Study