Serum B-type natriuretic peptide: A marker of fluid resuscitation after injury?

Randall S Friese, Sean Dineen, Andrew Jennings, Jeffrey Pruitt, Dara McBride, Shahid Shafi, Heidi Frankel, Larry M. Gentilello

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND: Excessive volume resuscitation after injury is associated with severe complications. B-type natriuretic peptide (BNP) is secreted from myocardium under increased wall stretch and is used in medical intensive care units (ICUs) as a noninvasive method to detect heart failure. However, the use of BNP as a marker of fluid overload during resuscitation from injury has not been previously described. METHODS: Serum BNP levels were prospectively followed in 134 trauma ICU patients. Levels were obtained at admission and at 12, 24, and 48 hours. Repeated measures analysis of variance was used to test for differences in BNP levels over time. Post hoc pairwise comparisons were made with Bonferroni correction when the omnibus test indicated significance. Chest films were obtained at 24 hours and scored for the presence of pulmonary edema by a radiologist blinded to BNP measurements (n = 45). Twenty-four hour BNP levels for patients with or without radiographic evidence of pulmonary edema were compared using nonparametric analysis (Mann-Whitney U). RESULTS: Admission BNP levels were low and increased with fluid resuscitation over time in all patients (p = 0.002) as well as in a subgroup of patients <60 years of age (p = 0.003). At 24 hours, 25 patients had no pulmonary edema evident on chest X-ray, whereas 20 were scored indicating that pulmonary edema was present. Patients with evidence of pulmonary edema had higher mean BNP levels at 24 hours (110 ± 31 pg/mL) than did patients without edema (47.0 ± 10.8 pg/mL) (p = 0.04). CONCLUSIONS: Serum BNP levels increase with resuscitation after injury and levels are higher in patients who develop pulmonary edema. These findings suggest that BNP might be a marker of excessive volume resuscitation after injury.

Original languageEnglish (US)
Pages (from-to)1346-1350
Number of pages5
JournalJournal of Trauma
Volume62
Issue number6
DOIs
StatePublished - Jun 2007
Externally publishedYes

Fingerprint

Brain Natriuretic Peptide
Resuscitation
Pulmonary Edema
Wounds and Injuries
Serum
Intensive Care Units
Thorax
peptide A
Motion Pictures
Edema
Myocardium
Analysis of Variance
Heart Failure
X-Rays

Keywords

  • B-type natriuretic peptide
  • Injury
  • Pulmonary edema
  • Resuscitation

ASJC Scopus subject areas

  • Surgery

Cite this

Friese, R. S., Dineen, S., Jennings, A., Pruitt, J., McBride, D., Shafi, S., ... Gentilello, L. M. (2007). Serum B-type natriuretic peptide: A marker of fluid resuscitation after injury? Journal of Trauma, 62(6), 1346-1350. https://doi.org/10.1097/TA.0b013e31804798c3

Serum B-type natriuretic peptide : A marker of fluid resuscitation after injury? / Friese, Randall S; Dineen, Sean; Jennings, Andrew; Pruitt, Jeffrey; McBride, Dara; Shafi, Shahid; Frankel, Heidi; Gentilello, Larry M.

In: Journal of Trauma, Vol. 62, No. 6, 06.2007, p. 1346-1350.

Research output: Contribution to journalArticle

Friese, RS, Dineen, S, Jennings, A, Pruitt, J, McBride, D, Shafi, S, Frankel, H & Gentilello, LM 2007, 'Serum B-type natriuretic peptide: A marker of fluid resuscitation after injury?', Journal of Trauma, vol. 62, no. 6, pp. 1346-1350. https://doi.org/10.1097/TA.0b013e31804798c3
Friese, Randall S ; Dineen, Sean ; Jennings, Andrew ; Pruitt, Jeffrey ; McBride, Dara ; Shafi, Shahid ; Frankel, Heidi ; Gentilello, Larry M. / Serum B-type natriuretic peptide : A marker of fluid resuscitation after injury?. In: Journal of Trauma. 2007 ; Vol. 62, No. 6. pp. 1346-1350.
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AU - Dineen, Sean

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AU - Pruitt, Jeffrey

AU - McBride, Dara

AU - Shafi, Shahid

AU - Frankel, Heidi

AU - Gentilello, Larry M.

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N2 - BACKGROUND: Excessive volume resuscitation after injury is associated with severe complications. B-type natriuretic peptide (BNP) is secreted from myocardium under increased wall stretch and is used in medical intensive care units (ICUs) as a noninvasive method to detect heart failure. However, the use of BNP as a marker of fluid overload during resuscitation from injury has not been previously described. METHODS: Serum BNP levels were prospectively followed in 134 trauma ICU patients. Levels were obtained at admission and at 12, 24, and 48 hours. Repeated measures analysis of variance was used to test for differences in BNP levels over time. Post hoc pairwise comparisons were made with Bonferroni correction when the omnibus test indicated significance. Chest films were obtained at 24 hours and scored for the presence of pulmonary edema by a radiologist blinded to BNP measurements (n = 45). Twenty-four hour BNP levels for patients with or without radiographic evidence of pulmonary edema were compared using nonparametric analysis (Mann-Whitney U). RESULTS: Admission BNP levels were low and increased with fluid resuscitation over time in all patients (p = 0.002) as well as in a subgroup of patients <60 years of age (p = 0.003). At 24 hours, 25 patients had no pulmonary edema evident on chest X-ray, whereas 20 were scored indicating that pulmonary edema was present. Patients with evidence of pulmonary edema had higher mean BNP levels at 24 hours (110 ± 31 pg/mL) than did patients without edema (47.0 ± 10.8 pg/mL) (p = 0.04). CONCLUSIONS: Serum BNP levels increase with resuscitation after injury and levels are higher in patients who develop pulmonary edema. These findings suggest that BNP might be a marker of excessive volume resuscitation after injury.

AB - BACKGROUND: Excessive volume resuscitation after injury is associated with severe complications. B-type natriuretic peptide (BNP) is secreted from myocardium under increased wall stretch and is used in medical intensive care units (ICUs) as a noninvasive method to detect heart failure. However, the use of BNP as a marker of fluid overload during resuscitation from injury has not been previously described. METHODS: Serum BNP levels were prospectively followed in 134 trauma ICU patients. Levels were obtained at admission and at 12, 24, and 48 hours. Repeated measures analysis of variance was used to test for differences in BNP levels over time. Post hoc pairwise comparisons were made with Bonferroni correction when the omnibus test indicated significance. Chest films were obtained at 24 hours and scored for the presence of pulmonary edema by a radiologist blinded to BNP measurements (n = 45). Twenty-four hour BNP levels for patients with or without radiographic evidence of pulmonary edema were compared using nonparametric analysis (Mann-Whitney U). RESULTS: Admission BNP levels were low and increased with fluid resuscitation over time in all patients (p = 0.002) as well as in a subgroup of patients <60 years of age (p = 0.003). At 24 hours, 25 patients had no pulmonary edema evident on chest X-ray, whereas 20 were scored indicating that pulmonary edema was present. Patients with evidence of pulmonary edema had higher mean BNP levels at 24 hours (110 ± 31 pg/mL) than did patients without edema (47.0 ± 10.8 pg/mL) (p = 0.04). CONCLUSIONS: Serum BNP levels increase with resuscitation after injury and levels are higher in patients who develop pulmonary edema. These findings suggest that BNP might be a marker of excessive volume resuscitation after injury.

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