Changes in microvascular blood flow during coupled plasma filtration and adsorption.

A 51-year-old man with septic shock underwent three consecutive sessions of coupled plasma filtration-adsorption each lasting 12 hours. Sublingual microvascular perfusion was assessed using the orthogonal polarisation spectral imaging technique at three different times: immediate pre-coupled plasma filtration-adsorption phase, two hours following commencement and two hours after its termination. The video images of the sublingual microcirculation were analysed by an investigator blinded to the time of image acquisition. The De Backer's score was calculated. During the coupled plasma filtration-adsorption, the number of perfused vessels increased compared with the pre-coupled plasma filtration-adsorption period, but decreased again after its termination. It is arguable that the elimination of septic mediators during the procedure could account for the observed variations.

B-type natriuretic peptide as a predictor of outcome in a general intensive care unit.

BACKGROUND: B-type natriuretic peptide is a hormone secreted by the heart in response to ventricular wall stress. Increased B-type natriuretic peptide plasma levels are also found as a consequence of noncardiac conditions including sepsis, surgery-induced systemic inflammatory response syndrome and kidney failure. Since these conditions are common in general intensive care unit patients, we hypothesized that B-type natriuretic peptide could be a helpful marker in predicting outcome in this setting. METHODS: We measured plasma B-type natriuretic peptide concentrations in 228 patients at admission to our general intensive care unit. The primary aim of the study was to investigate the relationship between B-type natriuretic peptide and hospital mortality. The secondary aim of the study was to investigate the association between B-type natriuretic peptide and severity of disease, quantified by the Simplified Acute Physiology Score II. RESULTS: Logistic regression revealed a positive association between B-type natriuretic peptide level and in-hospital death (OR= 1.59; 95% CI 1.30 to 1.95; p<0.0001) and a Cox proportional hazards regression model showed that B-type natriuretic peptide was significantly associated with the risk of death (HR=1.27; 95% CI 1.11 to 1.46; p=0.0005). B-type natriuretic peptide was higher in patients who died in the hospital than in those who survived (371.20 pg/ml vs. 127.10 pg/ml; p<0.0001). There was a positive correlation between B-type natriuretic peptide and Simplified Acute Physiology Score II (r=0.50; 95% CI 0.40 to 0.59; p<0.0001). DISCUSSION: B-type natriuretic peptide on admission is an independent prognostic marker of outcome in an unselected cohort of critically ill patients.