Mechanical ventilation with positive end-expiratory pressure decreases the circulating concentrations of the N-terminus and C-terminus of the atrial natriuretic factor prohormone.
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| Abstract |
Mechanical ventilation with positive end-expiratory pressure (PEEP) decreases urine output and urinary sodium excretion. The influence of PEEP during controlled mechanical ventilation on the circulating concentrations of the N-terminus and C-terminus of the atrial natriuretic factor (ANF) prohormone which both contain natriuretic and diuretic peptides was investigated in 7 patients with acute respiratory failure. The 98 amino acid (aa) N-terminus, the midportion of the N-terminus consisting of aa 31-67 of the 126 aa ANF prohormone (i.e., pro ANF 31-67) and the C-terminus (aa 99-126; ANF) were found to be significantly (p less than 0.05; ANOVA) elevated compared to 54 healthy volunteers during acute respiratory failure prior to institution of PEEP. With institution of 10 cm of H2O of PEEP all 7 patients had a significant (p less than 0.05) decrease in the circulating concentrations of pro ANFs 1-98, 31-67 and ANF. These findings suggest that the increased thoracic pressure secondary to PEEP which reduces venous return and lowers atrial filling pressure results in a decreased release of the N-terminus and C-terminus of the ANF prohormone. This decrease in the N-terminus and C-terminus of the ANF prohormone appears to represent a physiologic mechanism for restoration of intravascular volume, secondary to decreased sodium excretion.
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| Authors | D L Vesely, J S Salmon |
| Journal | Respiration; international review of thoracic diseases (Respiration) Vol. 57 Issue 6 Pg. 389-94 ( 1990) ISSN: 0025-7931 [Print] Switzerland |
| PMID | 2151585 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.) |
| Chemical References |
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