title: Effectiveness of human atrial natriuretic peptide supplementation in pulmonary edema patients using the pulse contour cardiac output system.
abstract: OBJECTIVE
  Atrial natriuretic peptide (ANP) has a variety of pharmacologic effects, including natriuresis, diuresis, vasodilatation, and suppression of the reninangiotensin system. A recent study showed that ANP infusion improved hypoxemia and pulmonary hypertension in a lung injury model. On the other hand, the pulse contour cardiac output (PiCCO(TM)) system (Pulsion Medical Systems, Munich, Germany) allows monitoring of the intravascular volume status and may be used to guide volume therapy in severe sepsis and critically ill patients.
  
  
  METHODS
  We treated 10 pulmonary edema patients without heart disease with human ANP (HANP). The patients were divided into two groups: a group with normal Intrathoracic Blood Volume (ITBV) (900-1100 mL/m(2)) (n = 6), and a group with abnormal ITBV (n = 4), as measured by the PiCCO(TM) device; the extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI) in the two groups were compared.
  
  
  RESULTS
  The average patient age was 63.9 +/- 14.4 years. The normal ITBV group showed significant improvement of the EVLW (before, 16.7 +/- 2.7 mL/kg; after, 10.5 +/- 3.6 mL/kg; p = 0.0020) and PVPI (before, 3.2 +/- 0.3; after, 2.1 +/- 0.7; p = 0.0214) after the treatment. The abnormal ITBV group showed no significant improvement of either the EVLW (before, 16.3 +/- 8.9 mL/kg; after, 18.8 +/- 9.6 mL/kg; p = 0.8387) or PVPI (before, 2.3 +/- 0.8; after, 2.7 +/- 1.3; p = 0.2782) after the treatment. In both groups, the EVLW and PVPI were strongly correlated with the chest X-ray findings.
  
  
  CONCLUSIONS
  We conclude that HANP supplementation may improve the EVLW and PVPI in pulmonary edema patients without heart disease with a normal ITBV. The PiCCO(TM) system seems to be a useful device for the management of pulmonary edema.
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba Hokusou Hospital, Nippon Medical School 1715, Kamakari, Inba-mura, Inba-gun, Chiba 270-1694, Japan. y-sakamoto@nms.ac.jp
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Mashiko
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Saito
authors.forename: Hisashi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Hara
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Kutsukata
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D002302:Cardiac Output / Q000187:drug effects* / Q000502:physiology*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D011654:Pulmonary Edema / Q000188:drug therapy* / Q000503:physiopathology*
chemical_list: D009320:Atrial Natriuretic Factor