The consequences of continuous haemofiltration on lung mechanics and extravascular lung water in a porcine endotoxic shock model.
Endotoxinaemia (E. coli endotoxin, 0.111.B4) and pulmonary hypertension were evoked in 20 swine, randomly assigned to receive either zero-balanced venovenous haemofiltration (HF) with an ultrafiltration and replacement rate of 600 ml/h (HF group, n = 10) or to undergo an uninfluenced spontaneous course (E group, n = 10) during a constant infusion of endotoxin until the end of the experiment. Endotoxin-induced pulmonary dysfunction was assessed on the basis of extravascular lung water (EVLW) using a thermo-dye technique via a fiberoptic intra-aortic probe, gas exchange and lung mechanics, the latter derived by a pressure-volume loop (P/V loop) of the respiratory system (super syringe, flow 30 ml/s, tidal volume 600 ml). A comparable increase in alveolo-arterial oxygen difference and a constant EVLW was observed in both groups. The progressive deterioration of hysteresis area and compliance parameters by endotoxinaemia was significantly blunted by HF. Independent of an impact on pulmonary oedema zero-balanced HF modifies endotoxin induced lung injury, probably by the convective transport of mediator substances.
Stein
B
B
Department of Anaesthesiology, University Clinic, Ulm, Federal Republic of Germany.
Pfenninger
E
E
Grünert
A
A
Schmitz
J E
JE
Deller
A
A
Kocher
F
F
D000818:Animals; D004927:Escherichia coli Infections / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D015633:Extravascular Lung Water; D005260:Female; D006440:Hemofiltration; D008297:Male; D011659:Pulmonary Gas Exchange; D015656:Respiratory Mechanics; D012772:Shock, Septic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D013997:Time Factors