Brain Natriuretic Peptide (BNP)
OVERVIEW
- released from ventricular myocytes in response to ventricular distension
- role in regulation of salt and water excretion and BP management (ADH antagonist)
Different assays
- BNP
- Pro-BNP
- N-terminal Pro BNP (we use this)
> 220 = LVF
< 40 = normal
CAUSES
Elevated in
- LV and RV dysfunction (systolic and diastolic)
- LVH
- massive or submassive PE
- cor pulmonale
- high dose steroids
- renal impairment
USEFULNESS
- excluding CHF
- monitoring of treatment response in CHF
- prognostication in CHF
- prognostication of death in AMI
- prognostication in MODS
- can rule out cardiogenic shock
- helps to quantify severity of PE (indicator of RV dysfunction) and decision to perform thrombolysis
- elevation of BNP in patients wit SAH may account in part for ‘cerebral’ wasting syndrome
LIMITATIONS
- role in ICU and ED settings is unclear
- costs $40 per test
- non-specific and often elevated in the critically ill
- doesn’t help differentiated between non-cardiogenic causes of shock
- no use in ARDS or fluid resuscitation
- highest elevations seen in post cardiac surgical and SAH patients
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC