title: Efficacy of continuous arteriovenous hemofiltration in endotoxic shock.
abstract: We determined the efficacy of continuous arteriovenous hemofiltration (CAVH) in removing tumor necrosis factor (TNF), thromboxane A2, and prostacyclin, and in improving survival in endotoxemia. Twelve rats were given 10 mg/kg of E. coli 0:127:B8 lipopolysaccharide. Fifteen min later, the rats were randomized to ultrafiltered or non-ultrafiltered groups. Blood and ultrafiltrate were collected for TNF, thromboxane B2 (TxB2), and 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha). After 4 hr, surviving rats were sacrificed. Five of 6 ultrafiltered and none of 6 non-ultrafiltered rats survived 4 hr. Plasma TxB2 > 1,000 pcg/ml and its rate of increase within the first 2 hr predicted death (P < 0.03). Ultrafiltration decreased the rate of rise in TxB2 (P < 0.04). Plasma TxB2 inversely correlated with TxB2 clearance by ultrafiltration. The concentration and rate of increase in TNF and 6-keto-PGF1 alpha did not predict survival. We conclude that CAVH improves short term survival in endotoxemia. Salutary effects appear to be due to thromboxane A2 removal.
authors.affiliation: Department of Pediatric, Children's Hospital of Michigan, Detroit 48201, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Heidemann
authors.forename: J P
authors.initials: JP
authors.lastname: Ofenstein
authors.forename: A P
authors.initials: AP
authors.lastname: Sarnaik
mesh_terms: D000818:Animals; D011464:Epoprostenol / Q000302:isolation & purification; D004926:Escherichia coli; D006440:Hemofiltration; D008070:Lipopolysaccharides; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D012772:Shock, Septic / Q000139:chemically induced / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013928:Thromboxane A2 / Q000097:blood / Q000302:isolation & purification; D014409:Tumor Necrosis Factor-alpha / Q000302:isolation & purification
chemical_list: D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D013928:Thromboxane A2; D011464:Epoprostenol