Abstract
Background: Early goal-directed therapy (EGDT) has been shown to improve patient outcomes. Treatment of patients unresponsive to the protocol, however, is difficult and the result is occasionally fatal. Recently, continuous renal replacement therapy (CRRT) has been used to treat acute kidney injury (AKI) to improve survival. We examined the effectiveness of CRRT in treating septic shock patients with concurrent AKI who are not amenable to EGDT. Methods: We studied 17 patients who underwent emergency surgery for intra-abdominal infection; these patients experienced AKI complications and did not respond to EGDT within 6 hrs after intensive care unit (ICU) admission. We treated patients with continuous venovenous hemodiafiltration (CVVHDF; dialysis = 900 ml/hr, filtration = 900 ml/hr, total hemopurification = 1800 ml/hr). We measured mean arterial pressure (MAP), central venous pressure (CVP), central venous oxygen saturation (ScvO 2 ), catecholamine index (CAI), and determined serum concentrations of lactate, interleukin-6 (IL-6), and high mobility group box-1 protein (HMGB-1) immediately before and 3, 6, 12, 24, 48 hrs after CRRT initiation. We also evaluated 28-day survival, ICU survival, and hospital survival. Results: CRRT duration was 6.5±4.2 days. MAP and ScvO 2 significantly increased with CRRT, while CAI and concentrations of lactate, IL-6, and HMGB-1 significantly decreased. After CRRT, no patients required intermittent hemodialysis in the ICU. Mean ICU stay was 15.1±10.4 days. ICU survival, 28-day survival, and hospital survival were 76.5%, 76.5%, and 70.6%, respectively. Conclusions: CRRT may be an effective treatment for seriously ill patients who have complications of AKI and are unresponsive to EGDT.
Highlights
Septic shock is associated with poor prognosis and can lead to multiple organ failure for reasons such as tissue hypoxia
Among the treatments recommended by Sepsis Campaign Guidelines (SSCG), early goal-directed therapy (EGDT) has been shown to improve survival rates of septic shock patients in a randomized study carried out at a single institution [3]
The subjects of this study were 17 patients who underwent emergency surgery for intra-abdominal infection at the Oita University Hospital Surgery Unit between April 2007 and March 2010. These patients were admitted to the intensive care unit (ICU) with septic shock; the goals of Early goal-directed therapy (EGDT) were not met within 6 hours of entering the ICU and the patients developed complications of acute kidney injury (AKI)
Summary
Septic shock is associated with poor prognosis and can lead to multiple organ failure for reasons such as tissue hypoxia. To improve the efficacy of treatments for severe sepsis and septic shock, the Surviving Sepsis Campaign Guidelines (SSCG) were recently developed [2]. Among the treatments recommended by SSCG, early goal-directed therapy (EGDT) has been shown to improve survival rates of septic shock patients in a randomized study carried out at a single institution [3]. Some patients develop complications of acute kidney injury (AKI), which makes treatment of concurrent sepsis difficult. Goal-directed therapy (EGDT) has been shown to improve patient outcomes. Continuous renal replacement therapy (CRRT) has been used to treat acute kidney injury (AKI) to improve survival.
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