The efficiency of continuous renal replacement therapy for rewarming of patients in accidental hypothermia--An experimental study.

Abstract

Severe accidental hypothermia carries high mortality and morbidity and is often treated with invasive extracorporeal methods. Continuous veno-venous hemodiafiltration (CVVHDF) is widely available in intensive care units. We sought to provide theoretical basis for CVVHDF use in rewarming of hypothermic patients. CVVHDF system was used in the laboratory setting. Heat balance and transferred heat units were evaluated for the system without using blood. We used 5L of crystalloid solution at the temperature of approximately 25°C, placed in a thermally insulated tank (representing the "central compartment" of a hypothermic patient). Time of warming the central compartment from 24.9 to 30.0°C was assessed with different flow combinations: "blood" (central compartment fluid) 50 or 100 or 150mL/min, dialysate solution 100 or 1500mL/h, and substitution fluid 0 or 500mL/h. The total circulation time was 1535minutes. There were no differences between heat gain values on the filter depending on blood flow (P=.53) or dialysate flow (P=.2). The mean heating time for "blood" flow rates 50, 100, and 150mL/min was 113.7minutes (95% CI, 104.9-122.6minutes), 83.3minutes (95% CI, 76.2-90.3minutes), and 74.7minutes (95% CI, 62.6-86.9minutes), respectively (P<.01). The respective median rewarming rate for different "blood" flows was 3.6°C/h (IQR, 3.0-4.2°C/h), 4.8 (IQR, 4.2-5.4°C/h), and 5.4 (IQR, 4.8-6.0°C/h), respectively (P<.01). The dialysate flow did not affect the warming rate. Based on our experimental model, CVVHDF may be used for extracorporeal rewarming, with the rewarming rates increasing achieved with higher blood flow rates.