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B-type natriuretic peptide, corrected flow time and central venous pressure as predictors of fluid responsiveness in septic shock

Introduction

The plasma B-type natriuretic peptide concentration (BNP) appears not to predict fluid responsiveness in septic shock but no account has been made for the potential influence of cardiac rhythm [1]. Also, no comparison has been made between BNP and other clinical guides to fluid therapy, such as the Doppler aortic flow time corrected for heart rate (FTc) or central venous pressure (CVP). The aim of this preliminary study was to compare BNP, FTc and CVP as predictors of fluid responsiveness in septic shock patients without cardiac dysrhythmia.

Methods

A prospective study of 10 consecutive adult septic shock patients (in sinus rhythm; 60% mechanically ventilated) treated with intravenous fluid challenge (4% albumin 250 ml over 15 min) in an Australian tertiary ICU. Results presented as the mean ± SD.

Results

The APACHE II score was 21.8 ± 12.7. Haemodynamic assessment incorporating transcutaneous aortic Doppler (USCOM®) occurred before and 5 minutes after fluid challenge. Concurrent with the initial assessment, blood samples were collected for BNP assay (ADIVA Centaur®). Four patients demonstrated an increase in stroke volume ≥ 15% (responders). Three of the responders had an elevated baseline BNP (>144 pg/ml). The percentage change in stroke volume correlated with baseline FTc (r = -0.81; P = 0.004) but not with BNP (r = -0.3; P = 0.4) or CVP (r = -0.4; P = 0.2).

Conclusion

Our data confirm that neither BNP nor CVP appear to predict fluid responsiveness. Furthermore, elevated BNP should not be viewed as a contraindication to fluid challenge in septic shock, as it does not exclude favourable haemodynamic response. Transcutaneous FTc offers promise as a predictor of fluid responsiveness and should be evaluated further.

References

  1. 1.

    Pirracchio R, et al.: Impaired plasma B-type natriuretic peptide clearance in human septic shock. Crit Care Med 2008, 36: 2542-2546. 10.1097/CCM.0b013e318183f067

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Sturgess, D., Pascoe, R., Scalia, G. et al. B-type natriuretic peptide, corrected flow time and central venous pressure as predictors of fluid responsiveness in septic shock. Crit Care 13, P200 (2009). https://doi.org/10.1186/cc7364

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Keywords

  • Central Venous Pressure
  • Fluid Responsiveness
  • Septic Shock Patient
  • Fluid Challenge
  • Predict Fluid Responsiveness