{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:45:44Z","timestamp":1782492344233,"version":"3.54.5"},"reference-count":27,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Research Fund of Sichuan Academy of Medical Science","award":["2023QN02"],"award-info":[{"award-number":["2023QN02"]}]},{"name":"Sichuan Science and Technology Program","award":["25QNJJ3955"],"award-info":[{"award-number":["25QNJJ3955"]}]},{"name":"Tibet Kangzhe Pharmaceutical Development Co","award":["2025HX007"],"award-info":[{"award-number":["2025HX007"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,4,27]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In the de-resuscitation phase of septic shock, resolving vasoplegia and fluid mobilisation can increase venous congestion in patients with sepsis-related myocardial dysfunction. This study will characterise the haemodynamic effects and safety of recombinant human brain natriuretic peptide (rh-BNP) in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This single-centre, prospective, single-arm study will enrol 30 adults recovering from septic shock with improving infection\/vasopressor trends, sinus rhythm, ongoing pulse-index continuous cardiac output (PiCCO) monitoring and measurable arm-equilibrium pressure (Parm). Eligibility will require cardiac dysfunction (left-ventricular ejection fraction \u226450% and\/or \u226510% absolute decline when available) and volume overload (global end-diastolic volume index &gt;800\u2009mL\/m\u00b2 and extravascular lung water index &gt;10\u2009mL\/kg). Participants will receive rh-BNP (2\u2009\u00b5g\/kg intravenous bolus over 15\u2009min, then a 0.01\u2009\u00b5g\/kg\/min infusion for up to 72\u2009hours). Measurements will be obtained at baseline, acute response (30\u201360\u2009min), 24, 48 and 72\u2009hours. The primary outcome will be within-patient change in venous return pressure gradient (\u0394PVR, Parm\u2212central venous pressure) from baseline to acute response. Secondary outcomes will include indices of preload, cardiac function, tissue perfusion and venous congestion. Haemodynamic instability will be the safety endpoint. Paired tests and repeated-measures analyses will estimate within-patient changes over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval has been obtained from the Ethics Committee of Sichuan Provincial People\u2019s Hospital, Sichuan Academy of Medical Sciences (No. 2024-653-1). Written informed consent will be obtained. Findings will be disseminated via peer-reviewed publications and conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06745206\">NCT06745206<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110628","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T05:40:25Z","timestamp":1779687625000},"page":"e110628","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Recombinant human brain natriuretic peptide for the recovery stage of septic shock: an interventional study protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06745206","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06745206","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Jing-Chao","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People\u2019s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Mou","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People\u2019s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ma","family":"Li","sequence":"additional","affiliation":[{"name":"Medical Administration Department, Sichuan Academy of Medical Sciences and Sichuan Provincial People\u2019s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Tao","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People\u2019s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui-Ming","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People\u2019s Hospital, University of Electronic Science and Technology of China, 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