BNP en réanimation : quelles perspectives chez le malade ventilé ?

The purpose of this review is to present the physiology and utility of B type natriuretic peptide (BNP) with a focus on its role in critical illness and artificial ventilation. BNP is a powerful diagnostic and prognostic tool for left heart failure (systolic or diastolic) and right heart failure (pulmonary embolism, chronic obstructive pulmonary disease, primary or secondary pulmonary hypertension). BNP level is correlated to filling pressures and it is a useful adjunct in tailoring therapy to patients with chronic or decompensated heart failure. Many constitutive factors influence BNP level, including gender, age and body weight. BNP is increased in critically ill patients, as compared to controls and may serve as a marker of severity and prognosis in this setting. Although the presence of cardiac disease is the most important determinant for BNP variations in intensive care, other factors also contribute significantly, including renal failure, sepsis, subarachnoid haemorrhage, and cardiac surgery. BNP may be useful in differentiating cardiogenic from noncardiogenic pulmonary edema. Preliminary data also suggest its ability to predict weaning outcome during the course of assisted mechanical ventilation.