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eComment: Brain natriuretic peptide is removed by continuous veno-venous hemofiltration in pediatric patients

Bakoulev Scientific Center for Cardiovascular Surgery, Roublevskoye Sh 135, 121552 Moscow, Russia

Brain natriuretic peptide is removed by continuous veno-venous hemofiltration in pediatric patients

The paper by Zaccaria Ricci et al. [1] deals with the problem of complex intensive care in infants after surgical correction of complex congenital heart defects. In particular, the authors consider the question of the optimization of brain natriuretic peptide (BNP) concentration during continuous high volume veno-venous hemofiltration (CVVH). The authors present data on high BNP clearance (over 35.6 ml/min) with CVVH, while the clearance of high-molecular-weight substances (myoglobin, troponin) is significantly lower. In our opinion, good elimination of BNP can be explained by several factors: (1) Low (3472 dalton) molecular mass of BNP facilitating its free passage through the hemofilter membrane; (2) the use of synthetic polyacrylonitryl membrane with perfect adsorption properties; (3) the use of high volume hemofiltration, which significantly increases the clearance of low- and medium-molecular weight substances.

On the other hand, the authors used CVVH in combination with ECMO, which makes it very difficult to reveal the cause of blood BNP concentration decrease. It can be due either to the improvement of the circulatory system's function (it is well known that BNP is a maker of heart failure) in response to ECMO addition, or to CVVH conduction. Unfortunately, the clinical state of patients during ECMO and CVVH virtually is not presented in this article, thus an adequate evaluation of the efficacy of the technique used is quite difficult. This appears to be an initial stage of a big work made by the anesthesiologist Zaccaria Ricci from the Ospedale Bambino Gesu in Rome.

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1. Ricci Z, Garisto C, Morelli S, Di Chiara L, Ronco C, Picardo S. Brain natriuretic peptide is removed by continuous veno-venous hemofiltration in pediatric patients. Interact CardioVasc Thorac Surg 2009;9:33–36.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Permission Requests Google Scholar Articles by Bockeria, L. A. Articles by Yarustovsky, M. PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Yarustovsky, M. Related Collections Related Article