Effect of intravenous atrial natriuretic peptide on pulmonary dysfunction and renal function following burn shock.
BACKGROUND
The typical response to burn stress causes burn shock, followed by a diuretic phase; however, fluid management remains crucial in this phase in the treatment of the elderly, patients with preexisting cardiac or renal diseases, and patients developing acute renal failure. We studied the effects of human atrial natriuretic peptide (hANP), which is a renal vasodilator, natriuretic, and inhibitor of renin secretion, on renal function in these patients with burn injuries.


METHODS
Thirty-three severely burned patients (44.8% +/- 20.6% total burn surface area) with prolonged cardiovascular overload and pulmonary edema after burn shock receiving a continuous infusion of hANP (0.025 microg/kg/min and 0.05 microg/kg/min, hANP group) were compared with control (no-hANP group, n = 25). Vital signs, urine output (UO) and blood gas analysis before and 72 hour after the start of hANP were recorded. Creatinine clearance, free water clearance, and fractional excretion of sodium were also calculated.


RESULTS
Sixteen (48%) patients were elderly, over 80 years old. Twenty (60%) had preexisting cardiovascular disease, renal insufficiency, or diabetes. hANP infusion increased UO in 25 (66%) cases and improved oxygenation in 31 (82%) cases. Treatment with hANP increased creatinine clearance, fractional excretion of sodium, and UO, except in four cases that had already progressed to complete renal failure before the infusion of hANP.


CONCLUSIONS
Intravenous hANP seems to be effective for postresuscitative pulmonary dysfunction and renal function after burn shock in the vulnerable elderly, or patients with preexisting disease, suggesting that it could be valuable in facilitating fluid management in the acute phase in severely burned patients.
Department of Emergency and Critical Care Medicine, Tokyo Medical University, Tokyo, Japan. junoda@v001.vaio.ne.jp
Jun
J
Oda
Kosuke
K
Kasai
Mitsuhiro
M
Noborio
Yoshiki
Y
Aoki
Katsuyuki
K
Yamashita
Takuya
T
Inoue
Masashi
M
Ueyama
Tetsuo
T
Yukioka
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use*; D001784:Blood Gas Analysis; D002053:Burn Units; D002056:Burns / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D015601:Injury Severity Score; D007668:Kidney / Q000187:drug effects*; D007677:Kidney Function Tests; D008168:Lung / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011336:Probability; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000187:drug effects; D018570:Risk Assessment; D012774:Shock, Traumatic / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D009320:Atrial Natriuretic Factor