Yonsei Med J.  2010 May;51(3):354-359. 10.3349/ymj.2010.51.3.354.

Effectiveness of Human Atrial Natriuretic Peptide Supplementation in Pulmonary Edema Patients Using the Pulse Contour Cardiac Output System

• Sakamoto Y
• Mashiko K
• Saito N
• Matsumoto
• Hara Y
• Kutsukata
• Yokota H

• KMID: 1074986
• DOI: http://doi.org/10.3349/ymj.2010.51.3.354

Abstract

PURPOSE
Atrial natriuretic peptide (ANP) has a variety of pharmacologic effects, including natriuresis, diuresis, vasodilatation, and suppression of the renin-angiotensin 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 METHODS
We 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/m2) (n = 6), and a group with abnormal ITBV (n = 4), as measured by the PiCCOtrade mark device; the extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI) in the two groups were compared.
RESULTS
The 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.
CONCLUSION
We 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.

Keyword

Human atrial natriuretic peptide (HANP); pulmonary edema; pulse contour cardiac output (PiCCO)

MeSH Terms

Aged
Atrial Natriuretic Factor/administration & dosage/*therapeutic use
Cardiac Output/*drug effects/*physiology
Female
Humans
Injections, Intravenous
Male
Middle Aged
Monitoring, Physiologic/*instrumentation
Pulmonary Edema/*drug therapy/*physiopathology

Figure

• 

  Fig. 1 Classification of pulmonary edema based on the IBPV as measured using the PiCCO system. Results of categorization by the PiCCO system, of pulmonary edema patients in whom a precise diagnosis of pulmonary edema could not be made. IBPV, Intrathoracic Blood Volume; PiCCO, pulse contour cardiacoutput.

• 

  Fig. 2 Changes of chest X-ray findings after carperitide therapy (case 1). Pre treatment: The chest X-ray permeability finding was abnormal. Post treatment: The normal ITBV cases showed improvement of the EVLW, and the PaO2/FiO2 ratio was correlated with the improvement of the chest X-ray permeability findings.

• 

  Fig. 3 Changes of chest X-ray findings after carperitide therapy (case 2). Pre treatment: The chest X-ray permeability finding was abnormal. Post treatment: The normal ITBV cases showed improvement of the EVLW, and the PaO2/FiO2 ratio was correlated with the improvement of the chest X-ray permeability findings just like case 1.

• 

  Fig. 4 Change of chest X-ray findings after HANP therapy (case 7). Pre treatment: The chest X-ray permeability finding was abnormal. Post treatment: The abnormal ITBV cases showed no improvement of the EVLW, and the PaO2/FiO2 ratio was not correlated with the chest X-ray permeability findings.

• 

  Fig. 5 Changes of chest X-ray findings after HANP therapy (case 8). Pre treatment: The chest X-ray permeability finding was abnormal. Post treatment: The abnormal ITBV cases showed no improvement of the EVLW, and the PaO2/FiO2 ratio was not correlated with the chest X-ray permeability findings just like case 7.

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