Brain Natriuretic Peptide (BNP)


  • 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


Elevated in

  • LV and RV dysfunction (systolic and diastolic)
  • LVH
  • massive or submassive PE
  • cor pulmonale
  • high dose steroids
  • renal impairment


  • 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


  • 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

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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