NT-proBNP in ICU Postoperative/Posttraumatic Patients With Shock
NT-proBNP in ICU Postoperative/Posttraumatic Patients With Shock
The purpose of this study is to determine the course of NT-proBNP plasma concentrations in
 the context of confounding parameters in postoperative/posttraumatic critically ill patients
 with severe SIRS/sepsis and shock.
In the recent sepsis-definitions, myocardial depression is included in the definition of
 severe sepsis, indicated as lowered cardiac index or echocardiographically documented cardiac
 dysfunction. Myocardial dysfunction occurs in greater than 50% of patients with severe sepsis
 and septic shock. In this context, B-type natriuretic peptid (BNP) from ventricular myocytes
 may serve as a surrogate biomarker for the evaluation and quantification of myocardial
 dysfunction. Biologically active BNP is cleaved into inactive NT-proBNP, which is supposed to
 be a better marker of myocardial dysfunction and prognosis in patients with severe sepsis and
 septic shock. However, severity of illness dependent association of myocardial dysfunction,
 especially left ventricular diastolic function, dosage of norepinephrine, NT-proBNP and
 biomarker plasma concentrations has not been systematically investigated in
 postoperative/posttraumatic patients in septic shock or volume-deficiency/hemorrhagic shock.
 Moreover, data regarding NT-proBNP plasma concentrations and renal function in
 postoperative/posttraumatic patients are sparse. Therefore, this prospective observational
 study will enroll n= 200 postoperative/posttraumatic patients to monitor longitudinally
 NT-proBNP, biomarkers, and cell surface markers on leukocytes to find out whether there is a
 discriminating pattern of myocardial dysfunction, NT-proBNP and biomarkers in patients with
 non-septic or septic shock, respectively, and with beneficial or harmful outcome.
Inclusion Criteria:

 -  Critically ill, postoperative/posttraumatic patients with severe systemic inflammatory
 response syndrome (SIRS) or severe sepsis

 Exclusion Criteria:

 -  Life expectancy < 24 hours

 -  Participation in other trials

 -  Known or suspected pregnancy

 -  Contraindications for transesophageal echocardiography (TEE): severe disease of the
 esophagus (hernia, strictures, esophageal resection, severe bleeding disorders)