tailieunhanh - Báo cáo y học: "B-type natriuretic levels in critically ill patients: critically misleadin"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: B-type natriuretic levels in critically ill patients: critically misleading? | Available online http content 13 4 163 Commentary B-type natriuretic levels in critically ill patients critically misleading Hisham Dokainish Department of Medicine Baylor College of Medicine 6620 Main Street Houston TX 77030 USA Corresponding author Hisham Dokainish hishamd@ Published 13 July 2009 This article is online at http content 13 4 163 2009 BioMed Central Ltd Critical Care 2009 13 163 doi cc7938 See related research by Meaudre et al. http content 13 3 R76 Abstract Although B-type natriuretic peptide BNP has been used for the diagnosis of congestive heart failure in many clinical settings its diagnostic role in critically ill patients remains uncertain. The body of literature suggests that BNP and N-terminal pro-BNP levels are not useful for the diagnosis of systolic or diastolic heart failure in the critically ill including in patients with brain hemorrhage due to poor specificity. However these cardiac peptides may have a more promising prognostic role in this patient population. In the previous issue of Critical Care Meaudre and colleagues measured bedside rapid assay B-type natriuretic peptide BNP levels daily and performed bedside echocardiography in patients admitted to hospital for subarachnoid hemorrhage SAH 1 . They found that BNP levels rose in 25 31 81 patients peaking at day 2 at a mean of 126 ng ml and tapering off by day 7. Importantly BNP levels did not correlate with left ventricular LV filling pressure as estimated by echocardiography. BNP levels did correlate with cardiac troponin I levels at day 2 and day 3 R P and R P respectively . The authors therefore concluded that BNP cannot estimate LV filling pressure in SAH patients but does correlate with myocardial necrosis as assessed by cardiac troponin I levels in these patients without prior hypertensive or cardiac disease. What is the mechanism of BNP release in such patients As Meaudre and colleagues mention .