Recombinant Human Brain Natriuretic Peptide for the Recovery Stage of Septic Shock

Inclusion Criteria

• •1. Age \>18 years.
• •2. Septic shock in recovery phase with decreasing vasopressor requirements, which is defined as:
• •1. Fulfilling the Sepsis-3 definition of septic shock at initial stage.
• •2. Hemodynamic stability achieved after adequate initial resuscitation and individualized hemodynamic optimization.
• •3. Controlled infection source with 48-hour trend of improving temperature, white blood cell count, and procalcitonin.
• •4. 48-hour trend of decreasing vasopressor requirements and transition to negative fluid balance.
• •5. Adequate perfusion with warm extremities, and capillary refill time \<3 seconds.
• •3. Ongoing pulse index continuous cardiac output (PiCCO) hemodynamic monitoring and sinus rhythm.
• •4. Volume indicators above the lower limit of normal range, with global end-diastolic volume index (GEDI) \>680 mL/m2 and central venous pressure (CVP) \>8 mmHg.
• •5. Signs of cardiac dysfunction: BNP\>200\[10\] or NT-proBNP \>900 pg/ml\[6\] or reduced ejection fraction (LVEF) \< 50%.
• •6. No bolus dose of diuretics had been administered in the previous 6 hours.
• •7. Informed consent obtained from patient/legal representative.