• Yonsei medical journal · May 2010

    Clinical Trial

    Effectiveness of human atrial natriuretic peptide supplementation in pulmonary edema patients using the pulse contour cardiac output system.

    • Yuichiro Sakamoto, Kunihiro Mashiko, Nobuyuki Saito, Hisashi Matsumoto, Yoshiaki Hara, Noriyoshi Kutsukata, and Hiroyuki Yokota.
    • 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
    • Yonsei Med. J. 2010 May 1; 51 (3): 354-9.

    PurposeAtrial 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.Materials And MethodsWe 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.ResultsThe 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.ConclusionWe 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.

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