title: Volume assessment in mechanically ventilated critical care patients using bioimpedance vectorial analysis, brain natriuretic Peptide, and central venous pressure.
abstract: Purpose. Strategies for volume assessment of critically ill patients are limited, yet early goal-directed therapy improves outcomes. Central venous pressure (CVP), Bioimpedance Vectorial Analysis (BIVA), and brain natriuretic peptide (BNP) are potentially useful tools. We studied the utility of these measures, alone and in combination, to predict changing oxygenation. Methods. Thirty-four mechanically ventilated patients, 26 of whom had data beyond the first study day, were studied. Relationships were assessed between CVP, BIVA, BNP, and oxygenation index (O(2)I) in a cross-sectional (baseline) and longitudinal fashion using both univariate and multivariable modeling. Results. At baseline, CVP and O(2)I were positively correlated (R = 0.39; P = .021), while CVP and BIVA were weakly correlated (R = -0.38; P = .025). The association between slopes of variables over time was negligible, with the exception of BNP, whose slope was correlated with O(2)I (R = 0.40; P = .044). Comparing tertiles of CVP, BIVA, and BNP slopes with the slope of O(2)I revealed only modest agreement between BNP and O(2)I (kappa = 0.25; P = .067). In a regression model, only BNP was significantly associated with O(2)I; however, this was strengthened by including CVP in the model. Conclusions. BNP seems to be a valuable noninvasive measure of volume status in critical care and should be assessed in a prospective manner.
authors.affiliation: Division of Nephrology, London Health Sciences Center, London, Canada N6A 5A5.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: House
authors.forename: Mikko
authors.initials: M
authors.lastname: Haapio
authors.forename: Paolo
authors.initials: P
authors.lastname: Lentini
authors.forename: Ilona
authors.initials: I
authors.lastname: Bobek
authors.forename: Massimo
authors.initials: M
authors.lastname: de Cal
authors.forename: Dinna N
authors.initials: DN
authors.lastname: Cruz
authors.forename: Grazia M
authors.initials: GM
authors.lastname: Virzì
authors.forename: Rizzieri
authors.initials: R
authors.lastname: Carraro
authors.forename: Giampiero
authors.initials: G
authors.lastname: Gallo
authors.forename: Pasquale
authors.initials: P
authors.lastname: Piccinni
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco