[Natriuretic peptides--relevance in intensive care].

The family of natriuretic peptides consists of the atria natriuretic peptide (ANP), the cerebral natriuretic peptide (BNP), the type C natriuretic peptide (CNP) and the peptide isolated from the dendroaspis snakes' poison (DNP), whose presence in humans has not been confirmed. The physiological function of ANP is in the control of arterial blood pressure by regulation of systemic vascular resistance of blood vessels. BNP is produced as one of the factors in the acute response to inflammatory tissue damage, mainly in coronary vessels. Increased serum concentrations of natriuretic peptides have been found in stress situations, such as trauma or major surgery, systemic hypotension, and in intrinsic myocardial dysfunction. High concentrations of natriuretic peptides were observed in severe sepsis, septic shock and in multiple organ failure, probably due to increased secretion by mediators of the inflammatory process.The highest concentrations of ANP and BNP were found in lethal conditions. On admission to ICU, the measurement of natriuretic peptide concentrations could be very helpful in differentiating the etiology of respiratory failure, and for assessment of the severity of ARDS. Quick tests for measurement of natriuretic peptides, so-called the "point of care testing (POCT)" are fast, easy to perform and, not requiring expensive equipment, are relatively cheap. Therefore, the assessment of natriuretic peptide may be used in scoring a patient's clinical status, for precise diagnosis in doubtful situations, and for determining appropriate treatment.