Plasma atrial natriuretic peptide concentrations in patients weaning from positive-pressure ventilation

The effect of positive-pressure ventilation on plasma atrial natriuretic peptide (ANP) concentrations was investigated in sixteen patients weaning from the ventilator. During spontaneous ventilation plasma ANP concentrations rose significantly from 59 (16-270) to 67 (13-320) pg/ml (median and range, P less than 0.05) and mean arterial blood pressure rose from 84 +/- 3 to 92 +/- 3 mmHg (mean +/- SEM, P less than 0.05) if compared with periods of positive-pressure ventilation. This increase in plasma ANP concentrations occurred irrespective of the underlying disease and the wide scatter of the ANP plasma levels found in individual patients. As right atrial stretch is the major stimulus for the release of the ANP the data indicate a decrease in cardiac output during positive-pressure ventilation following an impaired central venous return to the heart.