INTRODUCTION: It is difficult to adjust fluid balance adequately in patients with severe burns due to various physical changes. B-type natriuretic peptide (BNP) is emerging as a potential marker of hydration state. Proteinuria is used as a predictor of outcome in severe illness and might correlate to systemic capillary leakage. This study investigates whether combining BNP and proteinuria can be used as a guide for individualized resuscitation and as a predictor of outcome in patients with severe burns.METHODS: From 2006 to 2009, 38 consecutive patients (age 47 ± 15 years, 74% male) with severe burns were included and followed for 20 days. All had normal kidney function at admission. BNP and proteinuria were routinely measured. Ordered and actually administered fluid resuscitation volumes were recorded. The Sequential Organ Failure Assessment (SOFA) score was used as the measure of outcome.RESULTS: BNP increased during follow-up, reaching a plateau level at Day 3. Based on median BNP levels at Day 3, patients were divided into those with low BNP and those with high BNP levels. Both groups had comparable initial SOFA scores. Patients with high BNP received less fluid from Days 3 to 10. Furthermore, patients with a high BNP at Day 3 had less morbidity, reflected by lower SOFA scores on the following days. To minimize effects of biological variability, proteinuria on Days 1 and 2 was averaged. By dividing the patients based on median BNP at Day 3 and median proteinuria, patients with high BNP and low proteinuria had significantly lower SOFA scores during the entire follow-up period compared to those patients with low BNP and high proteinuria.CONCLUSIONS: Patients with higher BNP levels received less fluid. This might be explained by a lower capillary leakage in these patients, resulting in more intravascular fluid and consequently an increase in BNP. In combination with low proteinuria, possibly reflecting minimal systemic capillary leakage, a high BNP level was associated with a better outcome. BNP and proteinuria have prognostic potential in severely burned patients and may be used to adjust individual resuscitation.
Rede in verkorte vorm uitgesproken bij de installatie als lector duurzame energievoorziening bij de Saxion Hogescholen op 19 maart 2004 in Enschede door Dr.W.Gilijamse. Iedere dag wordt door de NOS het radioprogramma “Met het oog op morgen” uitgezonden. Zo worden de late luisteraars naar Radio 1 voorbereid op de dag van morgen. Onze energievoorziening is niet ingericht “met het oog op morgen”. In het huidige jargon: onze energievoorziening is niet duurzaam. Het is mijn missie bij te dragen aan een energievoorziening die wel voorbereid is op de dag van morgen. Deze missie deel ik met veel mensen en met veel wat zeker ook leeft bij de Saxion Hogescholen. Een week geleden werd bij de Saxion Hogeschool IJselland in Deventer Theo de Bruijn geïnstalleerd als lector duurzame ontwikkeling van de leefomgeving. Eerder vandaag heeft u kunnen vernemen wat er bij de Saxion Hogeschool Enschede al vóór mijn komst als lector is gedaan aan energie-efficiency en duurzame energie.
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