Effectiveness of human atrial natriuretic peptide supplementation in pulmonary edema patients using the pulse contour cardiac output system.
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.
Sakamoto
Yuichiro
Y
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
Mashiko
Kunihiro
K
Saito
Nobuyuki
N
Matsumoto
Hisashi
H
Hara
Yoshiaki
Y
Kutsukata
Noriyoshi
N
Yokota
Hiroyuki
H
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*
D009320:Atrial Natriuretic Factor