• Young Ae Kang, Moo Suk Park, Eun Young Kim, Byung Hoon Park, Ju Eun Lim, and Ji Young Son.
• Pulmonary and Critical Care Division, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea.
• J Crit Care. 2011 Jun 1;26(3):241-8.

PurposeThe 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).Materials And MethodsTwenty-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.ResultsRight-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).ConclusionsIn 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.Copyright © 2011 Elsevier Inc. All rights reserved.

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