Effects Of Continuous Hemofiltration Research Articles

Effect of continuous hemofiltration on severe acute pancreatitis with different intra-abdominal pressure: A cohort study.

Background:The clinical efficacy and timing of continuous veno-venous hemofiltration (CVVH) in the treatment of severe acute pancreatitis (SAP) remain uncertain. In this prospective cohort study, patients with SAP were classified according to intra-abdominal pressure (IAP).Methods:Seventy-four patients with SAP admitted to the intensive care unit were randomly divided into group A (IAP ≥20 mm Hg) and group B (with IAP ≤20 mm Hg). Then, according to whether CVVH was administered or not, groups A and B were divided into 4 subgroups: group A1 and B1 (non-CVVH treatment), group A2 and B2 (CVVH treatment). Changes in clinical and laboratory indicators were recorded before and on the seventh day after treatment, and clinical outcomes were analyzed.Results:Before treatment, there was no significant difference in general conditions between subgroups A1 and A2, and between subgroups B1 and B2. After CVVH treatment, the indicators recorded in group A2 were significantly improved compared to those in group A1 (P < .05). In group A2, the 28 day operation rate was lower (P < .05), as mechanical ventilation, gastric decompression, and intensive care unit treatment time were shorter (P < .05). However, there was no statistically significant difference in any of the above indicators between subgroups B (P > .05). Groups A2 and B2 had more days of negative fluid balance within 1 week of admission than groups A1 and B1 (P < .05).Conclusions:For SAP, patients with IAP ≥20 mm Hg can benefit from treatment with CVVH, but for patients with IAP ≤20 mm Hg, the efficacy is not clear, and monitoring IAP may be an indicator to decide whether or when to initiate CVVH. Negative fluid balance caused by CVVH treatment may be one of the reasons for the benefit of this group of patients.

Continuous hemofiltration improves the prognosis of bacterial sepsis complicated by liver dysfunction in children

BackgroundLiver dysfunction is an independent risk factor for poor prognosis of patients with sepsis. The aim of this study is to evaluate the effects of continuous hemofiltration in patients with bacterial sepsis complicated by liver dysfunction.MethodsWe retrospectively analyzed the medical records of 27 cases of bacterial sepsis with liver dysfunction admitted to pediatric intensive care unit (PICU) of Shanghai Children’s Hospital between January 2013 and December 2016.Results28-day mortality and length of PICU stay were significantly reduced in the continuous hemofiltration group (n = 16) compared with the conventional management group (n = 11) (31.3% vs. 72.7%, 9 [4–23] vs. 14 [4–36], respectively, both P < 0.05). The interval time between PICU admission and continuous hemofiltration initiation was (22.06 ± 17.68) h, and the median time of continuous hemofiltration duration was 48 h (31–70 h). After 72 h hemofiltration, the levels of total bilirubin (TBIL), direct bilirubin (DBIL), total bile acids (TBA), ammonia, lactate (Lac), TNF-α and IL-6 were significantly decreased in the continuous hemofiltration group. Moreover, multivariate logistic regression analysis indicated that continuous hemofiltration treatment and the TBIL level were independently associated with 28-day mortality of patients with bacterial sepsis complicated by liver dysfunction.ConclusionsContinuous hemofiltration significantly decreases the serum levels of TBIL, DBIL, TBA, Lac, ammonia, TNF-α, IL-6, and improves 28-day mortality of patients with bacterial sepsis complicated by liver dysfunction.

The effect of continuous hemofiltration in the treatment of traumatic patients with refractory acute cephalocele after craniotomy

To investigate the effect and the possible mechanism of continuous hemofiltration in the treatment of traumatic patients with refractory acute cephalocele. Continuous venous-venous hemofiltration (CVVH) was applied to 9 traumatic patients with refractory acute cephalocele after craniotomy. The changes in patients' physical signs, electrolytes, blood gas analysis, biochemical and blood clotting indexes as well as the outcome were observed. (1) The later the CVVH started, the worse the disorders became such as unstable body temperature, respiratory rate, heart rate, blood pressure and abnormal blood gas analysis. The most significant abnormality emerged with a delay of 12 hours. The above abnormalities returned to normal and kept stable within 12 hours of CVVH. CVVH maintained body temperature in hypothermic state, and serum lactic acid was kept at a low level without disturbance of blood coagulation function. (2) The duration between occurrence of cephalocele and beginning of CVVH was 2-16 hours, with a mean of (5.4±5.1) hours, the duration of CVVH was 23-129 hours, with a mean of (75.7±34.3) hours, and the net volume of liquid balance (NVLB) was -1.2-3.1 L, with a mean of (0.76±1.46) L. Height of encephalocele over skull window (HEOSW) was 51.8±10.0 mm and 51.0±10.0 mm before and 72 hours after CVVH. NVLB and HEOSW did not show obvious correlation with the prognosis of the patients. (3) Four patients survived, and 2 patients showed satisfactory outcome with Glasgow outcome scale (GOS) over 12 after follow-up for 3 months, and 2 patients showed improvement with GOS of 8 but in vegetative state 3 months later. Five patients died of respiratory failure and multiple organ dysfunction syndrome (MODS) 9-35 days after the termination of CVVH. CVVH was safe and effective in certain extent in the treatment of refractory acute cephalocele. The direct causes of death of the patients were complications instead of the cephalocele itself. The outcomes of the patients were related to the time of beginning of CVVH and the duration of CVVH, and there was nothing to do with the NVLB and the HEOSW. The study implicated that the effect of CVVH on these patients was not brain-dehydration solely. It also exerted certain effect on regulating water-electrolyte balance, acid-base balance and body temperature.

Effects of continuous hemofiltration on organ perfusion, energy metabolism, oxidative stress, endothelial dysfunction and inflammation

Continuous renal replacement therapies (CRRT) are widely used for treatment of acute kidney injury in critically ill patients. Little attention has been paid to the potential adverse effects of CRRT related to extracorporeal circuit bioincompatibility. Limited available evidence suggests that intermittent dialysis may compromise hepatosplanchnic perfusion in acute renal failure patients. By contrast, there are no data on the bio(in)compatibility indices in patients treated by CRRT. To investigate this issue, we utilized a long-term porcine model allowing a broad insight into organ hemodynamic, microvascular, metabolic and other pathways not accessible in human medicine.

Removal of circulating cytokines by continuous haemofiltration in patients with systemic inflammatory response syndrome or multiple organ dysfunction syndrome.

Abstract High continuous levels of plasma circulating cytokines have been reported in patients with systemic inflammatory response syndrome (SIRS)1. Such patients either produce excessive amounts of cytokines or cannot clear them from the circulation, and have been suggested to be at an increased risk of developing multiple organ dysfunction syndrome (MODS)2. In this context, cytokine removal may prevent the development of MODS. A study was therefore made of the effects of continuous haemofiltration (CHF) on blood levels of circulating cytokines and on pulmonary, cardiovascular or renal function in patients with SIRS or MODS.

Effect of continuous hemofiltration on hemodynamics, lung inflammation and pulmonary edema in a canine model of acute lung injury.

This study examined whether continuous hemofiltration favorably affects cardiopulmonary variables, lung inflammation, and lung fluid balance in a canine model of oleic acid induced acute lung injury. Eleven pentobarbital-anesthetized dogs were randomly divided into a control (mechanical ventilation, MV) group (n=6) and a MV plus hemofiltration (HF) group (n=5). All animals received an intravenous injection of oleic acid (0.09 ml/kg) to induce acute lung injury. Continuous arterial-venous hemofiltration (blood flow 100 ml/min, ultrafiltration rate at 50-65 ml kg(-1) h(-1)) was started after establishment of oleic acid induced acute lung injury and continued for 4 h. Hemodynamics, lung mechanics, gas exchange, lung fluid balance, lung histology, and the level of plasma cytokines were assessed. After 240 min of HF treatment there was a significant increase in cardiac output, reduction in pulmonary arterial pressure, and improvement in both oxygenation and lung mechanics. Also, in the HF group the lung wet-to-dry weight ratio was significantly reduced. Histologically, HF reduced edema and inflammatory cell infiltration in the lung. There was also a significantly greater decrease in plasma IL-6 and IL-8 levels in the HF group than in group receiving MV alone. In a canine model of acute lung injury continuous HF improved cardiopulmonary function, reduced pulmonary edema, decreased lung permeability and inflammation, and decreased the plasma concentration of proinflammatory cytokines.

High-volume hemofiltration.

The use of continuous hemofiltration has increased dramatically since its first description in 1977. It is now the dominant form of renal replacement therapy in Australia and is fast reaching a similar status in many European countries. Its growing use and the frequent observation of its beneficial effects in septic patients has directed the attention of researchers toward its application in the field of blood purification for sepsis. In this context, experimental studies have suggested that increasing the volume of ultrafiltrate produced may increase the beneficial effects of continuous hemofiltration. This so-called high-volume hemofiltration (HVHF) has now been demonstrated to have striking beneficial effects on hemodynamics in porcine septic shock. It has also been shown to attenuate gastrointestinal mucosal reperfusion injury in a model of gut ischemia. Furthermore, the infusion of ultrafiltrate obtained during HVHF into healthy pigs induces profound hypotension and myocardial depression, suggesting that vasodilatory and myocardial depressant substances may be removed during the procedure. Such animal experiments have led clinicians to conduct their first interventions with HVHF in humans with the multi-organ dysfunction syndrome and septic shock. The initial results are promising. They open up a new area for the investigation of HVHF as an adjuvant therapy in the management of severe sepsis, septic shock, and the multi-organ dysfunction syndrome.

High volume hemofiltration

The use of continuous hemofiltration has increased dramatically since its first description in 1977. It is now the dominant form of renal replacement therapy in Australia and is fast reaching a similar status in many European countries. Its growing use and the frequent observation of its beneficial effects in septic patients has directed the attention of researchers toward its application in the field of blood purification for sepsis. In this context, experimental studies have suggested that increasing the volume of ultrafiltrate produced may increase the beneficial effects of continuous hemofiltration. This so-called high-volume hemofiltration (HVHF) has now been demonstrated to have striking beneficial effects on hemodynamics in porcine septic shock. It has also been shown to attenuate gastrointestinal mucosal reperfusion injury in a model of gut ischemia. Furthermore, the infusion of ultrafiltrate obtained during HVHF into healthy pigs induces profound hypotension and myocardial depression, suggesting that vasodilatory and myocardial depressant substances may be removed during the procedure. Such animal experiments have led clinicians to conduct their first interventions with HVHF in humans with the multi-organ dysfunction syndrome and septic shock. The initial results are promising. They open up a new area for the investigation of HVHF as an adjuvant therapy in the management of severe sepsis, septic shock, and the multi-organ dysfunction syndrome.

The effect of continuous hemofiltration on acid-base physiology

Continuous hemofiltration techniques have a powerful effect on acid-base physiology. In patients with metabolic acidosis, hemofiltration techniques replace plasma water, which is low in bicarbonate concentration, with a solution, which contains either an above-normal bicarbonate concentration or a h

Effect of Continuous Hemofiltration on Phenytoin Elimination

Phenytoin is frequently used to treat seizure episodes in critically ill patients. Some of these patients have acute renal failure, requiring continuous hemofiltration to help maintain fluid and solute balance. We evaluated the removal of phenytoin in patients who received the drug while undergoing continuous hemofiltration treatment. Arterial and ultrafiltrate sample pairs were collected for phenytoin concentration determination. The ultrafiltrate drug concentrations were almost identical to the free serum phenytoin concentrations. Thus the ultrafiltrate/arterial drug concentration ratios resembled the percentages of serum free drug. Between 0.32 and 0.78 mg of phenytoin/h was removed by hemofiltration. The magnitude of hemofiltration phenytoin removal was related to the free drug concentration, total serum drug concentration, and ultrafiltration flow rate. When the ultrafiltration flow rate was low, the amount of phenytoin removed by hemofiltration was small relative to the usual daily dose. However, in patients with renal failure in whom serum phenytoin protein binding is substantially reduced, continuous hemofiltration at a high ultrafiltration rate may remove a clinically significant amount of the drug. Higher daily doses of phenytoin may be needed to maintain the therapeutic effect. Serum drug concentration monitoring will be necessary to determine the optimal dosage regimen.