BNP-Mediated Vasodilatation for Dialysis-Dependent Patient with Acute Heart Failure Syndrome in the Emergency Department

Figures & data

Table 1 Patient demographics

	Age (years)	Race/gender	Past medical history	Medications	Echocardiography	Time on nesiritide	Oxygen need, saturation	Disposition
1	40	AA/Female	HTN, Hep C	ACEI, Atenolol	Severe MS, MR, LVH, EF >55%	2h 3 min	5L NC95% on 2L	DC
2	31	AA/Male	HIV, HTN,Asthma	ACEI, Norvasc, Metoprolol	Moderate MR, LVH, EF > 55%	2h 0 min	50% FM90% RA	2 day Admit
3	56	AA/Male	HIV, HTN, CHF, Hep C	ACEI, Zocor, Phoslo	LVH, EF 30%, Hypocontractile	13h 8 min	2L NC95% RA	DC
4	73	AA/Female	CAD, CHF, HTN	Minoxidil, Phoslo,Metoprolol	Moderate MR, TR,LVH, PulmonaryHypertension	5h 15 min	50% FM85% 15L	2 day Admit
5	67	C/Male	Afib, CHF, DM	Digoxin, Insulin,Cardizem	EF 25%, hypocontractile	3h 40 min	4L NC88% RA	4 day Admit
6	39	AA/Female	HTN, Sarcoid, CAD, GERD	ACEI, Clonidine,NTG, Metoprolol	Moderate TR, LVH, EF > 55%	2h 0 min	BiPAP86% NRB	6 day Admit
7	41	AA/Male	HTN,Rhabdomyolysis	ACEI, Zocor, Phoslo	None Available	2h 15 min	2L NC97% RA	DC
8	31	AA/Male	Asthma, HTN, HIV	ACEI,Metoprolol,Norvasc	Moderate MR, LVH, EF > 55%	7h 0 min	15L NC87% RA	10 day Admit

Abbreviations: ACEI = angiotension-converting enzyme inhibitor, AA = African American, BiPAP = bi-level positive airway pressure, C = Caucasian, CAD = coronary artery disease, CHF = congestive heart failure, DM = diabetes mellitus, EF = ejection fraction, GERD = gastroesophageal reflux disease, H = hours, Hep C = hepatitis C, HIV = human immunodeficency virus, HTN = hypertension, L = liters, LVH = left ventricular hypertrophy, MR = mitral regurgitation, MS = mitral stenosis, Min = minute, NC = nasal cannula, NRB = non-rebreather, RA = room air, TR = tricuspid regurgitation.

Table 2 Change in vital sign parameters with nesiritide infusion

	ΔSBP (mmHg)	ΔDBP (mmHg)	ΔRR (RPM)	ΔHR (BPM)	Δ Dyspnea VAS (mm)	Δ APEX score (%)
1	+14	+19	−20	−35	71	51
2	−15	−3	−26	−3	48	45
3	−36	−19	−12	−1	57	80
4	−4	−18	−6	−25	24	68
5	0	+4	−11	+6	81	12
6	+2	−7	+2	−1	10	42
7	0	−21	+2	−3	62	62
8	−3	−25	+18	−6	48	27
Median	−1.5	−12.5	−8.5	−3	52.5	48%
Mean	−5.3	−8.8	−6.6	−8.5	50.1	48.4%
95% CI	+7 to −17.6	+3.8 to −21.3	+5 to −18.3	+3.2 to −20.2	33.8 to 66.4	33.1 to 63.7%

Represents difference of value immediately prior to infusion and immediately after discontinuing infusion. A negative value represents a reduction in the measurement.

Abbreviations: APEX = acute pulmonary edema score, BPM = beats per minute, DBP = diastolic blood pressure, HR = heart rate, mm = millimeters, mmHg = millimeters of mercury, RPM = respirations per minute, RR = respiratory rate, SBP = systolic blood pressure, VAS = visual analog scale.

Figure 1. Respiratory rate response with nesiritide infusion. Abbreviation: Min = minute, RR = respiratory rate.

Figure 2. APEX dyspnea score trends with nesiritide infusion. Abbreviation: Min = minute.

Figure 3. Patient dyspnea VAS trends with nesiritide infusion. Abbreviations: Min = minute, mm = millimeters.