Atrial and brain natriuretic peptide concentrations and the response to inhaled nitric oxide in patients with acute respiratory distress syndrome

Treggiari, Miriam M.; Bendjelid, Karim; Yanez, N. David; Heidegger, Claudia-Paula; Suter, Peter M.; Romand, Jacques-André

doi:10.1016/j.jcrc.2008.10.014

« Previous Next »Journal of Critical Care
Volume 25, Issue 1 , Pages 23-29, March 2010

Atrial and brain natriuretic peptide concentrations and the response to inhaled nitric oxide in patients with acute respiratory distress syndrome☆

Miriam M. Treggiari, MD, PhD, MPH
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Harborview Medical Center, PO Box 359724, Seattle, WA 98104, USA
- Corresponding author. Tel.: +1 206 731 5039; fax: +1 206 731 8090.
Karim Bendjelid, MD, PhD
- Division of Intensive Care, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Switzerland
N. David Yanez, PhD
- Department of Biostatistics, University of Washington, Seattle, WA, USA
Claudia-Paula Heidegger, MD
- Division of Intensive Care, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Switzerland
Peter M. Suter, MD
- University of Geneva, Geneva, Switzerland
Jacques-André Romand, MD
- Division of Intensive Care, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Switzerland

published online 17 February 2009.

Abstract

Purpose

The response to inhaled nitric oxide (iNO) is inconsistent in patients with acute respiratory distress syndrome (ARDS). We sought to determine whether the response to iNO, defined as 20% Pao₂/Fio₂ increase from baseline, depends on the level of cardiac natriuretic peptides.

Materials and methods

This is a prospective cohort study including 11 consecutive patients with ARDS who were eligible to receive iNO. Measurements of plasma concentrations of atrial natriuretic peptide (ANP), N-Terminal-Pro-B-Type Natriuretic Peptide (NT-pro-BNP) and 3′,5′-cyclic guanosine monophosphate were obtained before initiating iNO and 30 minutes later during iNO. Baseline cardiac peptides, oxygenation, and hemodynamic variables and their change during iNO were compared among responders and nonreponders to iNO.

Results

Baseline ANP and NT-pro-BNP concentrations were higher in patients that responded to iNO and tended to decrease during iNO in responders only. 3′,5′-Cyclic guanosine monophosphate concentrations were not different among responders and nonresponders and were unchanged during iNO. Baseline ANP was strongly correlated with change in intrapulmonary shunt, and baseline NT-pro-BNP and its change were correlated with the change in cardiac output.

Conclusions

High ANP and NT-pro-BNP concentrations are associated with the response to iNO. These data suggest that cardiac peptides have the potential to identify a subgroup of patients with ARDS who might derive clinical benefit from iNO.

Keywords: Adult respiratory distress syndrome, Acute lung injury, Atrial natriuretic factor, Cardiac natriuretic peptide hormones, Human