BNP as Predictor of Pediatric Severe Sepsis Fluid Responsiveness in Limited Resource Setting Country

Nanan Sekarwana¹, Heda Melinda Nataprawira^1, , Nur Melani Sari¹, Dadang Hudaya Somasetia¹ and Rahmat Budi Kuswiyanto¹

¹Department of Child Health, Dr. Hasan Sadikin General Hospital-Universitas Padjadjaran, Bandung, Indonesia

Cite this paper:
Nanan Sekarwana, Heda Melinda Nataprawira, Nur Melani Sari, Dadang Hudaya Somasetia and Rahmat Budi Kuswiyanto. BNP as Predictor of Pediatric Severe Sepsis Fluid Responsiveness in Limited Resource Setting Country. American Journal of Epidemiology and Infectious Disease. 2016; 4(6):105-109. doi: 10.12691/ajeid-4-6-1

Abstract

Fluid responsiveness is an important aspect in severe sepsis management, assessed by static and dynamic parameter tools. Unfortunately, they are not widely used in limited resource setting. Brain natriuretic peptide is cardiac hormone correlated with CVP measurement as one of the static parameter, but its associations with dynamic parameter has not studied yet. Objective: To investigate whether BNP might predict fluid responsiveness based on clinical and inferior vena cava index criteria. Study Design: A cross sectional study was conducted on 59 severe sepsis subjects aged 1–14 years who met the inclusion criteria enrolled through consecutive sampling during October 2013 to March 2014. Patients were given fluid resuscitation based on 2012 Surviving Sepsis Campaign. BNP measurements were performed at 0 and 1 hour after fluid resuscitation. Responder and non-responder groups were classified based on clinical and IVC index criteria. Ultrasound using M Mode was performed to calculate IVC index. Unpaired t test and receiver operating characteristic curves were generated for BNP to predict fluid responsiveness. Results: Baseline characteristics between responder and non-responder groups were almost similar. Initial BNP between groups using both criteria were not significantly different (p>0.05). The area under curve of BNP₀ was 0.04. The best cut off values of log BNP to predict fluid responsiveness was 1.9pg/mL. BNP ≤1.9 pg/mL has a sensitivity, specificity, negative predictive value and positive predictive value of each were 50%, 50%, 50%, 50%, respectively. Conclusion: BNP cannot reflect and accurately predict fluid responsiveness due to multifactorial factors of raising BNP and mostly subject were spontaneous breathing which more difficult to predict.

Keywords:
BNP severe sepsis fluid responsiveness

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References:

[1]	Watson RS, Carcillo JA. Scope and epidemiology of pediatric sepsis. Pediatr Crit Care Med. 2005; 6: S3-5.
[2]	Rivers EP, Jaehne AK, Wharry LE, Brown S, Amponshah D. Fluid therapy in septic shock. Curr Opin Crit Care. 2010; 16: 1-10.
[3]	Woodcock T, Woodcock T. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br J Anaesth. 2012; 108(3): 384-94.
[4]	Renner J, Scholz J. Monitoring fluid therapy. Best Practice & Research Clinical Anaesthesiology 2009; 23: 159071.
[5]	Marik PE, Lemson J. Fluid responsiveness: an evolution of our understanding. BJA. 2014;112(4: 617-20): 617-20.
[6]	Eyre L, Breen A. Optimal volaemic status and predicting fluid responsiveness. Anaesthesia, Critical Care & Pain. 2010; 10: 59-62.
[7]	Koch A, Zink S, Singer H. Normal values of B type natriuretic infants, children and adolescent. Heart. 2003; 89(7): 875-78.
[8]	Zhang Z, Zhang Z, Xue Y, Xu X, Ni H. Prognostic value of B type natriuretic peptide (BNP) and its potential role in guiding fluid therapy in critically ill septic patient. Scan J Trauma. 2012; 20(86): 1-7.
[9]	Zhongheng Zhang HN, Baolong Lu, Xiao Xu. Changes in brain natriuretic peptide are correlated with changes in global end-diastolic volume index. J Thorac Dis 2013; 5(2): 156-60.
[10]	Dipti A, Soucy Z, Surana A, Chandra S. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. American Journal of Emergency Medicine (2012) 30, 1414-1419e1. 2010.
[11]	Lyon ML, Verma N. Ultrasound Guided Volume Assessment Using Inferior Vena Cava Diameter The Open Emergency Medicine Journal. 2010; 3: 22-4.
[12]	Goldstein B, Giroir B, Randolp A. International pediatric sepsis consensus conference: Definition for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005; 6(2-8).
[13]	WHO.2006. WHO Growth Chart Standard.
[14]	Deep A, Goonasekera CDA, Wang Y, Brierley J. Evolution of haemodynamics and outcome of fluid-refractory septic shock in children. Intensive Care Med 2013; 39: 1602-9.
[15]	Majeed K. Ultrasound guided management of shock. 2010; Available from: http://rmsolutions.net.
[16]	Muller L, Bobbia X, Toumi M, Louart G, Molinari N, Ragonnet B, et al. Respiratory variations of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure: need for a cautious use. Crit Care 2012, 16: R188.
[17]	Dellinger R, Levy M, Carlet J, Bion J, Parker M, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2012. Intensive Care Med 2008. 2013; 34: 17-60.
[18]	Mc.Lean. The utility of stroke volume variability as a predictor of fluid responsiveness in critically ill children: a pilot study. Intensive Care Med. 2014; 40: 288-289.
[19]	Lemson J, Nusmeier A, Hoeven JG. Advanced Hemodynamic Monitoring in Critically Ill Children. Pediatrics 2011; 128: 3 560-571.
[20]	Eyre L, Breen A. Optimal volaemic status and predicting fluid responsiveness. Continuing Education in Anaesthesia, Critical Care & Pain j Volume 10 Number 2 2010. 2010.
[21]	Dipti A. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med. 2012 Oct; 30(8): 1414-1419.e1.
[22]	Muller L, Louart G, Teboul J, Mahamat A, A AP, Bertinchant J, et al. Could B-type Natriuretic Peptide (BNP) plasma concentration be useful to predict fluid responsiveness [corrected] in critically ill patients with acute circulatory failure? Ann Fr Anesth Reanim. 2009; 28(9): 816.
[23]	Sturgess D, RLPascoe, Scalia G, Venkatesh B. A comparison of transcutaneous Doppler corrected flow time, b-type natriuretic peptide and central venous pressure as predictors of fluid responsiveness in septic shock: a preliminary evaluation. Anaesth Intensive Care. 2010;38(2):336-41.
[24]	Ramos FJdS, Azevedo LCPd. Assessment of fluid responsiveness in patients under spontaneous breathing activity. Rev Bras Ter Intensiva. 2009; 21(2): 212-18.
[25]	Castillo J, Zagler A, Jimenez RC, Hennekens C. Brain natriuretic peptide: a potential marker for mortality in sptic shock. Int J Infect Dis. 2004; 8(5): 271-4.
[26]	Domico M, Liao P, Anas N, Mink RB. Elevation of brain natriuretic peptide levels in children with septic shock. Pediatr Crit Care Med. 2008; 9: 478-83.
[27]	Koc B, Sevketoglu E, Hatipoglu S, Salihoglu B, Demireli Y. Serum brain natriuretic peptide in children with septic shock. 2011.
[28]	Hartemink KJ, Twisk JWR, Groeneveld ABJ. High circulating N-terminal pro-B-type natriuretic peptide is associated with greater systolic cardiac disfunction and non responsiveness to fluid in septic vs non septic critically ill patients. J Crit Care. 2011; 26: 108e. 1-e8.
[29]	Omar S, Mathivha L, Ali A. Changes in B type natriuretic peptide and related hemodynamic parameter following a fluid challenge in patients with severe sepsis or septic shock. Crit Care. 2012; 16 Suppl 1.