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Hiperkapnik Solunum Yetmezliği Gelişen KOAH'lı Hastalarda Non-İnvaziv Ventilasyonun Plazma Brain Natriüretik Peptid (BNP) ve Troponin Üzerine Etkisi

The Effect of Noninvasive Ventilation on Plasma Brain Natriuretic Peptide (BNP) and Troponin in COPD Patients With Hypercapneic Respiratory Failure

Journal Name:

  • Selçuk Tıp Dergisi

Publication Year:

  • 2011

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
It was reported that there is relationship between high brain natriuretic peptide (BNP) levels and mortality in chronic obstructive pulmonary disease (COPD). In this study, we investigated effect of NIV to the BNP and troponin. Fifty eight cases with COPD were enrolled to this study. The patients were divided into two groups as cases receiving NIV (n:41) and cases not receiving NIV (n:17). In both groups pretreatment and posttreatment pro BNP and troponin levels were measured. Initially, in NIV group both pro-BNP (2013.95 pg/ml) and troponin (0.17 ng/ml) levels were significantly higher than those of control group (328.9 pg/ml and 0.02 ng/ml, respectively) (p<0.001). During treatment, while there was significant decrease in pro-BNP values (783.15 pg/ml) (p<0.01), no significant difference was present in troponin values (p>0.05). In conclusion, in severe COPD acute exacerbations that develop respiratory failure, both pro-BNP and troponin levels increase significantly. This increase suggests that in COPD exacerbations, depending on severity of exacerbation right ventricle load and pulmonary hypertension may be more prominent and myocardial injury may accompany this. In COPD exacerbations, NIV treatment could safely decrease the increased pro-BNP levels without increasing the myocardial injury.
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Abstract (Original Language): 
Kronik obstrüktif akciğer hastalığında (KOAH) yüksek BNP değerleri ile mortalite arasında ilişki olduğu bildirilmiştir. Bu çalışmada non-invaziv ventilasyonun (NIV) pro-BNP ve troponine etkisi araştırılmıştır. Bu çalışmaya KOAH'lı 58 hasta alınmıştır. Hastalar NIV uygulananlar (n:41) ve uygulanmayanlar (n:17) olarak iki gruba ayrıldı. Kontrol grubunda ve NIV uygulananlarda tedavi öncesi ve sonrası pro-BNP ve troponin değerleri ölçüldü. Başlangıçta NIV grubunda hem pro-BNP (2013.95 pg/ml) hem de troponin (0.17 ng/ml) seviyeleri kontrol grubundan (sırasıyla 328.9 pg/ml, 0.02 ng/ml) anlamlı olarak belirgin yüksekti (p<0.001). NIV grubunda tedavi sonrasında pro-BNP değerlerinde (783.15 pg/ml) anlamlı azalma varken (p<0.01), troponin değerlerinde anlamlı değişiklik yoktu (p>0.05). Solunum yetmezliği gelişen şiddetli KOAH akut alevlenmelerinde pro-BNP ve troponin seviyeleri belirgin artmaktadır. Bu artış KOAH alevlenmelerinde alevlenmenin şiddetine bağlı olarak sağ ventrikül yüklenmesinin ve pulmoner hipertansiyonun daha fazla olabileceğini ve buna miyokard hasarının da eklenebileceğini düşündürmektedir. NIV tedavisi hiperkapnik solunum yetmezliğinin geliştiği KOAH akut alevlenmelerinde artmış pro-BNP seviyelerini miyokard hasarını arttırmadan güvenli bir şekilde düşürmektedir.
FULL TEXT (PDF): 
PDF icon arastirmax-hiperkapnik-solunum-yetmezligi-gelisen-koahli-hastalarda-non-invaziv-ventilasyonun-plazma-brain-natriuretik-peptid-bnp-troponin-uzerine-etkisi.pdf
  • 3
142-145
  • Turkish

REFERENCES

References: 

1. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Commitee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global initiative for chronic obstructive pulmonary disease (GOLD) workshop summary. Am J Respir Crit Care Med 2001;163:1256-76.
2. Davis M, Espiner E, Richards G, Billings J, Town I, Neill A, et al. Plasma brain natriuretic peptide in assessment of acute dyspnoea. Lancet 1994;343:440-4.
3. Lang CC, Coutie WJ, Sthurders AD, Dhillon DP, Winter JH, Lipworth BJ.
Elevated levels of BNP in acute hypoxemic COPD. Clin Sci 1992;83:529-
33.
4. Leuchte HH, Baumgartner RA, Nounou ME, Vogeser M, Neurohr C, Trautnitz M, et al. Brain Natriuretic Peptide Is a Prognostic Parameter in Chronic Lung Disease. Am J Respir Crit Care Med 2006;173:744-50.
5. Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, et al. Noninvasive Ventilation For Acute Exacerbations Of Chronic Obstructive Pulmonary Disease. N Engl J Med 1995;333: 817-22.
6. Plant PK, Owen JL, Elliott MW. Non-invasive ventilation in acute exacerbations of chronic obstructive pulmonary disease: long term survival and predictors of in-hospital outcome. Thorax 2001;56:708-12.
7. Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 2003;326:185.
8. Baratz DM, Westbrook PR, Shah PK, Mohsenifar Z. Effect of nasal continuous positive airway pressure on cardiac output and oxygen delivery in patients with congestive heart failure. Chest 1992;102:1397-401.
9. Peter JV, Moran JL, Phillips-Hughes JK, Graham P, Bersten AD. Effect of
noninvasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet
2006;367:1155-63.
10. Adams JE, Bodor GS, Davila-Roman VG, Delmez JA, Apple FS, Ladenson JH, et al. Cardiac troponin-I. A marker with high specificity for cardiac injury. Circulation 1993;88:101-6.
11. Daniels LB, Maisel AS. Natriuretic peptides. J Am Coll Cardiol 2007;50:2357-
68.
12. Braunwald E. Biomarkers in Heart Failure. N Engl J Med. 2008;358:2148-
59.
13. Yetkin Ö, Aksoy Y, Turhan H, İn E, Karahan M, Kılıç T, ve ark. Akciğer ve Kalp Hastalıklarında plazma BNP düzeyinin prognostik değeri. Tüberküloz
ve Toraks Dergisi 2007;55:225-30.
14. Tulevski II, Groenink M, Van Der Wall EE, van Veldhuisen DJ, Boomsma F Stoker J, et al. Increased brain and atrial natriuretic peptides in patients with chronic right ventricular pressure overload: correlation between plasma neurohormones and right ventricular dysfunction. Heart 2001;86:27-30
15. Abrough F, Ouanes-Besbes L, Ncin N, Sellami N, Addad F, Hamda KB, et al. Association of left-heart dysfunction with severe exacerbation of chronic obstructive pulmonary disease:diagnostic performance of cardiac biomarkers. Am J Respir Crit Care Med 2006;174:990-6.
16. Girault C, Daundenthun I, Chevron V, Tamion F, Leroy J, Bonmarchand G. Noninvasive mechanical ventilation as a systematic extubation and weaning technique in acute or chronic respiratory failure. A prospective randomised controlled study. Am J Respir Crit Care Med 1999;160:86-92.
17. Diaz O, Iglesia R, Ferrer M, Zavala E, Santos C, Wagner PD, et al. Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute hypercapnic exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997;156:1840-5.
18. McLean AS, Tang B, Nalos B, Huang SJ, Stewart DE. Increased B-type natriuretic peptide (BNP) level is a strong predictor for cardiac dysfunction in intensive care unit patients. Anaesth Intensive Care 2003;31:21-7.
19. Almog Y, Novack V, Megralishvili R, Kobal S, Barski L, King D, et al. Plasma level of N terminal pro-brain natriuretic peptide as a prognostic marker in critically ill patients. Anesth Analg 2006 ;102:1809-15.
20. Turner A, Tsamitros M, Bellomo R. Myocardial cell injury in septic shock. Crit Care Med 1999;27:1775-80.
21. Guest TM, Ramanathan AV, Tuteur PG, Schechtman KB, Ladenson JH, Jaffe AS. Myocardial injury in critically ill patients. A frequently unrecognized complication. JAMA 1995;273:1945-9.
22. Maeder M, Fehr T, Rickli H, Ammann P. Sepsis-associated myocardial dysfunction: diagnostic and prognostic impact of cardiac troponins and natriuretic peptides. Chest 2006;129:1349-66.
23. Sommerer C, Giannitsis E, Schwenger V, Zeier M. Cardiac biomarkers in haemodialysis patients: the prognostic value of amino-terminal pro-B-type natriuretic peptide and cardiac troponin T. Nephron Clin Pract 2007;107:c77-81.
24. Becattini C, Manina G, Agnelli G. Determinants of prognosis in acute pulmonary embolism: the role of serum Troponins. Recenti Prog Med 2008;99:509-15.
25. Mehta S, Jay GD, Woolard RH, Hipona RA, Connolly EM, Cimini DM, et al. Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med 1997;25:620-8.
26. Bellone A, Monari A, Cortellaro F, Vettorello M, Arlati S, Coen D. Myocardial infarction rate in acute pulmonary edema: noninvasive pressure support ventilation versus continuous positive airway pressure. Crit Care Med 2004;32:1860-5.
27. Peter JV, Moran JL, Phillips-Hughes JK, Graham P, Bersten AD. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis. Lancet 2006;367:1155-63.
28. Gray A, Goodacre S, Newby DE, Masson M, Sampson F, Nicholl J. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008;359:142-51.

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