title: N-terminal pro-brain natriuretic peptide as a marker of right ventricular dysfunction after open-lung approach in patients with acute lung injury/acute respiratory distress syndrome.
abstract: OBJECTIVE
  The purpose of the study was to evaluate the utility of N-terminal pro-brain natriuretic peptide (NT-proBNP) as a marker of right ventricular (RV) dysfunction after open-lung approach (OLA) in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).
  
  
  METHODS
  Twenty-seven patients with ALI/ARDS underwent OLA (2-minute steps of fixed pressure-controlled ventilation with progressive positive end-expiratory pressure levels up to 30 cm H(2)O, followed by stepwise decrement of positive end-expiratory pressure level by 2 cm H(2)O). Patients who showed a PaO(2)/FiO(2) increase of more than 50% from baseline were defined as responders. Plasma NT-proBNP levels were taken immediately before OLA and 2 and 6 hours later. A minimum 30% increase in NT-proBNP level from baseline was considered significant.
  
  
  RESULTS
  Right-over-left ventricular stroke work ratio and its percentage change did not differ between responders and nonresponders, whereas these values were higher in patients showing NT-proBNP increase (P < .05). The NT-proBNP percentage change correlated with right-over-left ventricular stroke work ratio percentage change (r = 0.83), pulmonary vascular resistance (r = 0.81), and RV ejection fraction (r = -0.79) and correlated with plateau pressure in nonresponders only (r = 0.82).
  
  
  CONCLUSIONS
  In patients with ALI/ARDS, intraindividual NT-proBNP changes correlated with RV afterload following OLA, thereby serving as a potential marker for RV dysfunction after OLA.
authors.affiliation: Pulmonary and Critical Care Division, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Byung Hoon
authors.initials: BH
authors.lastname: Park
authors.forename: Young Sam
authors.initials: YS
authors.lastname: Kim
authors.forename: Joon
authors.initials: J
authors.lastname: Chang
authors.forename: Se Kyu
authors.initials: SK
authors.lastname: Kim
authors.forename: Young Ae
authors.initials: YA
authors.lastname: Kang
authors.forename: Ji Ye
authors.initials: JY
authors.lastname: Jung
authors.forename: Kyung Jong
authors.initials: KJ
authors.lastname: Lee
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Son
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Ju Eun
authors.initials: JE
authors.lastname: Lim
authors.forename: Moo Suk
authors.initials: MS
authors.lastname: Park
mesh_terms: D055371:Acute Lung Injury / Q000628:therapy*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011175:Positive-Pressure Respiration / Q000379:methods*; D056910:Republic of Korea; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain