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Early isovolaemic haemofiltration in oliguric patients with septic shock.
- Source :
- Intensive Care Medicine; Jan2006, Vol. 32 Issue 1, p80-86, 7p, 2 Charts, 1 Graph
- Publication Year :
- 2006
-
Abstract
- <bold>Objective: </bold>To evaluate the effects of early short-term, isovolaemic haemofiltration at 45 ml/kg/h on physiological and clinical outcomes in patients with septic shock.<bold>Design: </bold>Retrospective study before and after a change of unit protocol (study period 8 years).<bold>Setting: </bold>Intensive care unit of metropolitan hospital.<bold>Patients: </bold>Eighty patients with septic shock.<bold>Interventions: </bold>Introduction of a new septic shock protocol based on early isovolaemic haemofiltration (EIHF). In the pre-EIHF period (before), 40 patients received conventional supportive therapy. In the post-EIHF period (after), 40 patients received EIHF at 45 ml/kg/h of plasma-water exchange over 6 h followed by conventional continuous venovenous haemofiltration (CVVH). Anticoagulation policy remained unchanged.<bold>Measurements and Main Results: </bold>The two groups were comparable for age, gender and baseline APACHE II score. Delivered haemofiltration dose was above 85% of prescription in all patients. PaO2/FiO2 ratio increased from 117+/-59 to 240+/-50 in EIHF, while it changed from 125+/-55 to 160+/-50 in the control group (p<0.05). In EIHF patients, mean arterial pressure increased (95+/-10 vs 60+/-12 mmHg; p<0.05), and norepinephrine dose decreased (0.20+/-2 vs 0.02+/-0.2 microg/kg/min; p<0.05). Among EIHF patients, 28 (70%) were successfully weaned from the ventilator compared with 15 (37%) in the control group (p<0.01). Similarly, 28-day survival was 55% compared with 27.5% (p<0.05). Length of stay in the ICU was 9+/-5 days compared with 16+/-4 days (p<0.002).<bold>Conclusions: </bold>In patients with septic shock, EIHF was associated with improved gas exchange, haemodynamics, greater likelihood of successful weaning and greater 28-day survival compared with conventional therapy. [ABSTRACT FROM AUTHOR]
- Subjects :
- ACUTE kidney failure
RESPIRATORY distress syndrome
PATIENTS
SEPTIC shock
CRITICAL care medicine
THERAPEUTICS
TREATMENT of acute kidney failure
ADULT respiratory distress syndrome treatment
SEPTIC shock treatment
APACHE (Disease classification system)
BLOOD filtration
ADULT respiratory distress syndrome
OLIGURIA
SURVIVAL analysis (Biometry)
TREATMENT effectiveness
RETROSPECTIVE studies
CASE-control method
DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 03424642
- Volume :
- 32
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- Intensive Care Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 19316268
- Full Text :
- https://doi.org/10.1007/s00134-005-2815-x