[Continuous venovenous hemofiltration after cardiac surgery. A retrospective study in 16 patients with multiple organ failure].
As intermittent haemodialysis in critically ill patients is often associated with circulatory instability and hypotension, pumped continuous veno-venous haemofiltration (CVVH) has been proposed as an alternative. This technique was used postoperatively in 16 cardiac surgery patients with cardiogenic shock (cardiac index < 2.2 l.min-1.m-2), anuria and multiple organ failure. A mean haemofiltration rate of 0.5 to 1 l.h-1 was used. Average length of treatment was 57 +/- 38 h. Two patients were improved and weaned from CVVH after 96 and 144 h respectively. The other fourteen died. A mean 200 +/- 50 ml of liquid were removed every hour. The technique was well tolerated by the cardiovascular system. The systolic arterial pressure, heart rate and cardiac index remained unchanged. Body weight had decreased by 3 +/- 1 kg after 48 h of use. Similarly, serum creatinine concentration was lowered from 337 +/- 32 mmol.l-1 to 252 +/- 27 mmol.l-1 (p < 0.001). At that time, urea and creatinine clearances were 18 +/- 2 ml.min-1, and 15 +/- 1 ml.min-1 respectively. After 24 h of CVVH, both serum sodium and potassium concentrations had been decreased, from 148 +/- 3 mmol.l-1 to 142 +/- 2 mmol.l-1 (p < 0.001), and from 5.7 +/- 0.3 to 4.2 +/- 0.15 mmol.l-1 (p < 0.001) respectively. In addition, pH increased significantly from 7.13 +/- 0.1 to 7.30 +/- 0.04 (p < 0.001). These results were comparable with these of other authors regarding safety and efficiency of CVVH. The low patient survival rate (12.5%) was due to the severity of cardiac impairment.(ABSTRACT TRUNCATED AT 250 WORDS)
Lévy
B
B
Service de Chirurgie Cardiaque et de Transplantations cardiothoraciques, CHU de Nancy-Brabois, Vandoeuvre-lès-Nancy.
Clavey
M
M
Burtin
P
P
Dopff
C
C
Hubert
T
T
Villemot
J P
JP
D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000628:therapy*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*
Hémofiltration continue veinoveineuse après chirurgie cardiaque. Etude rétrospective chez seize patients en défaillance multiviscérale.