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Short-term ACE inhibition has no effect on sodium and water excretion during PEEP ventilation

Published online by Cambridge University Press:  16 August 2006

M. Wenz ,
N. Eckelt ,
F. Rissel  and
G. Kaczmarczyk
M. Wenz
Affiliation:
AG Experimental Anaesthesia, Department of Anaesthesiology and Operative Intensive Care Medicine, Virchow-Klinikum der Humboldt-Universität zu Berlin, Germany
N. Eckelt
Affiliation:
AG Experimental Anaesthesia, Department of Anaesthesiology and Operative Intensive Care Medicine, Virchow-Klinikum der Humboldt-Universität zu Berlin, Germany
F. Rissel
Affiliation:
AG Experimental Anaesthesia, Department of Anaesthesiology and Operative Intensive Care Medicine, Virchow-Klinikum der Humboldt-Universität zu Berlin, Germany
G. Kaczmarczyk
Affiliation:
AG Experimental Anaesthesia, Department of Anaesthesiology and Operative Intensive Care Medicine, Virchow-Klinikum der Humboldt-Universität zu Berlin, Germany
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Abstract

The short-term effect of intravenous (i.v.) angiotensin converting enzyme (ACE) inhibitor enalaprilat in 10 critically ill patients, being ventilated with positive end-expiratory pressure (PEEP), on sodium and water excretion was investigated. Mean arterial pressure (MAP) decreased. Heart rate and central venous pressure (CVP) did not change. Glomerular filtration rate (GFR), urine volume (V) and sodium excretion (UNaV) decreased in two patients with reduced MAP. GFR, V and UNaV increased in two patients with decreased MAP. No relation between changes in MAP and excretion was observed in six patients. ACE decreased in all patients. Plasma renin activity increased, aldosterone decreased, while atrial natriuretic peptide as well as antidiuretic hormone did not change. Enalaprilat did not facilitate sodium and water excretion during ventilation with PEEP. Decreased MAP indicates that the investigated patients were very dependent on their renin-angiotensin system to maintain systemic perfusion pressure. Base-line MAP and CVP values were no predictors of haemodynamic and excretory changes following acute ACE inhibition.

Keywords

renin-angiotensin systemangiotensin converting enzyme inhibitionenalaprilatpeeptrauma patientsicu patients
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 14 , Issue 6 , November 1997 , pp. 566 - 575
Copyright
1997 European Society of Anaesthesiology

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