Báo cáo y học: Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort study

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort study...
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Báo cáo y học: "Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort study" Available online http://ccforum.com/content/12/1/R3Research Open AccessVol 12 No 1Diagnostic utility of B-type natriuretic peptide in critically illpatients with pulmonary edema: a prospective cohort studyJoseph E Levitt1*, Ajeet G Vinayak2*, Brian K Gehlbach3, Anne Pohlman3, William Van Cleve4,Jesse B Hall3 and John P Kress31Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, 300 Pasteur Drive, MC 5236, Stanford, CA 94305, USA2University of Virginia Health Systems, PO 800546, Charlottesville, VA 22908, USA3University of Chicago Hospitals, 5841 S. Maryland Avenue, MC 6026, Chicago, IL 60637, USA4University of Washington School of Medicine, Pediatric Residency Program, Childrens Hospital and Regional Medical Center, 4800 Sand PointWay NE, PO Box 5371/G-0061, Seattle, WA 98105-0371, USA* Contributed equallyCorresponding author: Joseph E Levitt, jlevitt@stanford.eduReceived: 21 Jun 2007 Revisions requested: 24 Jul 2007 Revisions received: 21 Sep 2007 Accepted: 14 Jan 2008 Published: 14 Jan 2008Critical Care 2008, 12:R3 (doi:10.1186/cc6764)This article is online at: http://ccforum.com/content/12/1/R3© 2008 Levitt et al.; licensee BioMed Central Ltd.This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractIntroduction Distinguishing pulmonary edema due to acute lung Results We enrolled a total of 54 patients (33 with ALI/ARDSinjury (ALI) or the acute respiratory distress syndrome (ARDS) and 21 with cardiogenic edema). BNP levels were lower infrom hydrostatic or cardiogenic edema is challenging in critically patients with ALI/ARDS than in those with cardiogenic edemaill patients. B-type natriuretic peptide (BNP) can effectively (496 ± 439 versus 747 ± 476 pg/ml, P = 0.05). At an acceptedidentify congestive heart failure in the emergency room setting cutoff of 100 pg/ml, specificity for the diagnosis of ALI/ARDSbut, despite increasing use, its diagnostic utility has not been was high (95.2%) but sensitivity was poor (27.3%). Cutoffs atvalidated in the intensive care unit (ICU). higher BNP levels improved sensitivity at considerable cost to specificity. Invasive measures of filling pressures correlatedMethods We performed a prospective, blinded cohort study in poorly with initial BNP levels and subsequent day BNP valuesthe medical and surgical ICUs at the University of Chicago fluctuated unpredictably and without correlation withHospitals. Patients were eligible if they were admitted to the ICU hemodynamic changes and net fluid balance.with respiratory distress, bilateral pulmonary edema and acentral venous catheter suggesting either high-pressure(cardiogenic) or low-pressure (ALI/ARDS) pulmonary edema.BNP levels were measured within 48 hours of ICU admissionand development of pulmonary edema and onward up to three Conclusion BNP levels drawn within 48 hours of admission toconsecutive days. All levels were drawn simultaneously with the the ICU do not reliably distinguish ALI/ARDS from cardiogenicmeasurement of right atrial or pulmonary artery wedge pressure. edema, do not correlate with invasive hemodynamicThe etiology of pulmonary edema – cardiogenic or ALI/ARDS – measurements, and do not track predictably with changes inwas determined by three intensivists blinded to BNP levels. volume status on consecutive daily measurements.Introduction tiation of lung-protective ventilation [2]. Attributing pulmonaryEarly implementation of a lung protective ventilation strategy edema to volume overload or congestive heart failure maycan improve survival from acute lung injury and the acute res- explain some of this underdiagnosis. The American–Europeanpiratory distress syndrome (ALI/ARDS) [1]. However, a recent Consensus Conference definition of ALI/ARDS requires thesurvey of intensive care units (ICUs) found that a lack of phy- exclusion of left atrial hypertension [3]. However, advancedsician recognitio ...