Abstract

BackgroundLittle is known about the effects of renal replacement therapy (RRT) with fluid removal on intra-abdominal pressure (IAP). The global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) can easily be measured bedside by transpulmonary thermodilution (TPTD). The aim of this study is to evaluate the changes in IAP, GEDVI and EVLWI in critically ill patients receiving slow extended daily dialysis (SLEDD) or continuous venovenous haemofiltration (CVVH) with the intention of net fluid removal.MethodsWe performed a retrospective cohort study in ICU patients who were treated with SLEDD or CVVH and in whom IAP was also measured, and RRT sessions were excluded when the dose of vasoactive medication needed to be changed between the pre- and post-dialysis TPTD measurements and when net fluid loss did not exceed 500 ml. The TPTD measurements were performed within 2 h before and after SLEDD; in case of CVVH, before and after an interval of 12 h.ResultsWe studied 25 consecutive dialysis sessions in nine patients with acute renal failure and cardiogenic or non-cardiogenic pulmonary oedema. The GEDVI and EVLWI values before dialysis were 877 ml/m² and 14 ml/kg, respectively. Average net ultrafiltration per session was 3.6 l, with a net fluid loss 1.9 l. The GEDVI decreased significantly during dialysis, but not more than 47.8 ml/m² (p = 0.008), as also did the EVLWI with 1 ml/kg (p = 0.03). The IAP decreased significantly from 12 to 10.5 mmHg (p < 0.0001).ConclusionsNet fluid removal by SLEDD or CVVH in the range observed in this study decreased IAP, GEDVI and EVLWI in critically ill patients although EVLWI reduction was modest.

Highlights

  • Little is known about the effects of renal replacement therapy (RRT) with fluid removal on intraabdominal pressure (IAP)

  • Net fluid removal by slow extended daily dialysis (SLEDD) or continuous venovenous haemofiltration (CVVH) in the range observed in this study decreased IAP, global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) in critically ill patients EVLWI reduction was modest

  • Concern has recently been expressed that GEDVI may substantially overestimate the sum of the volumes of the four heart chambers at end-diastole [16], it has been extensively validated as a marker of cardiac preload, especially in intra-abdominal hypertension (IAH) [17,18,19,20]

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Summary

Introduction

Little is known about the effects of renal replacement therapy (RRT) with fluid removal on intraabdominal pressure (IAP). The aim of this study is to evaluate the changes in IAP, GEDVI and EVLWI in critically ill patients receiving slow extended daily dialysis (SLEDD) or continuous venovenous haemofiltration (CVVH) with the intention of net fluid removal. Several authors have studied the effects of different modalities of RRT on systolic and diastolic left and right ventricular functions in patients with chronic renal failure or congestive heart failure [1,2], but studies on changes in cardiac preload and extravascular lung water index (EVLWI) in critically ill patients are scarce [3,4,5]. The primary aim of this study was to evaluate the possible changes in IAP, GEDVI and EVLWI in critically ill patients receiving slow extended daily dialysis (SLEDD) or CVVH with the intention of net fluid removal. In a post hoc analysis, we evaluated whether ultrafiltration decreased EVLWI without excessive compromise of cardiac output

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