title: The effect of atrial natriuretic peptide infusion on intestinal injury in septic shock.
abstract: OBJECTIVE
  The aim of this study is to assess the effect of atrial natriuretic peptide (ANP) on intestinal ischemia-reperfusion injury in septic shock.
  
  
  METHODS
  A prospective randomized controlled, observer-blinded study was carried out in surgical Intensive Care Unit (ICU), University Hospital. Forty adult patients in septic shock were randomly divided into two groups, control group (Group C) received normal saline and ANP group (Group A) patients received ANP in the form of 1.5 mg vial added to 250 ml solvent in plastic bag (1 ml = 6 micg) given at 2 mcg/kg intravenous bolus over 1 min followed by 0.01 mcg/kg/min for 24 h. The primary outcome measurements were blood marker of intestinal hypoperfusion in form of intestinal fatty acid binding protein (I-FABP), malondialdehyde (MDA), myloperoxidase enzyme activity (MPO), protein carbonyl (PC), and glutathione peroxidase activity (GPA) measured before start of ANP infusion, 6 h, 12 h, and 24 h after start of infusion. The secondary outcome measurements were the duration of noradrenaline infusion, duration of ICU stay, hospital mortality rate, and complications related to ANP.
  
  
  RESULTS
  In comparison with Group C, Group A showed a significant decrease (P< 0.05) in serum level of MPO, MDA, PC, and I-FABP, with a significant increase (P< 0.05) in serum level of GPA, 6 h, 12 h, and 24 h after the start of ANP infusion. There was significant decrease (P< 0.05) in mean duration of noradrenaline infusion, the length of ICU stay and mortality rate in Group A in comparison with Group C. In Group A, seven patients had mean arterial blood pressure < 65 mmHg but respond to volume resuscitation, three patients serum sodium was 125-130 mmol/L.
  
  
  CONCLUSIONS
  In cases of septic shock, concomitant administration of ANP with noradrenaline may have a protective effect against intestinal injury through a decrease in the level of intestinal hypoperfusion owing to its anti-inflammatory and antioxidant effect.
authors.affiliation: Department of Anesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Ghada F
authors.initials: GF
authors.lastname: Elbaradey
authors.affiliation: Department of Anesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Nagat Sayed
authors.initials: NS
authors.lastname: Elshmaa
authors.affiliation: Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Hossam
authors.initials: H
authors.lastname: Hodeib
keywords: Atrial natriuretic peptide; Intensive Care Unit; chemical markers; ischemia-reperfusion injury