title: High volume hemofiltration improves hemodynamics and survival of pigs exposed to gut ischemia and reperfusion.
abstract: This study assesses the influence of high volume continuous hemofiltration on hemodynamics of pigs subjected to bowel ischemia/reperfusion. Twelve anesthetized and ventilated pigs were studied for 60 min during clamping of the superior mesenteric artery (SMA) and subsequently for 90 min after release of the clamp, while measuring global hemodynamics, SMA flow, and jejunal pCO2. They were randomly divided into two groups: pigs in "control" group were subjected to SMA clamping only. Pigs in "hemofiltered" group received zero-balanced, high volume, veno-venous hemofiltration with the removal of 6000 ml of ultrafiltrate/h, starting 30 min before clamping until 90 min after removal of the SMA clamp. Thereafter, pigs were allowed to awake and sacrificed after 24 h for macroscopic assessment of bowel damage. The drop in cardiac output (CO) during SMA clamping in the hemofiltered group was 2.5 +/- .3 L/min (mean +/- SE) (1.1/4.0; 95% confidence interval) smaller than in the control group. At the end of the experiment, mean arterial pressure (MAP) in the hemofiltered group was 33 +/- 6 (19/48) mmHg higher than in the control group, CO was 2.0 +/- .2 (1.2/2.8) L/min higher in the hemofiltered group. After 60 min of SMA clamping, left ventricular stroke work in the hemofiltered group was 35 +/- 4 (14/56) g higher than in the control group, and higher by 33 +/- 3 (21/46) g at 90 min after release of the SMA clamp. The mean pulmonary artery pressure, right atrial pressure, pulmonary artery wedge pressure, SMA flow and bowel wall pCO2 at different time points did not differ between groups.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Intensive Care, St. Clara Hospital, Rotterdam, The Netherlands.
authors.forename: A F
authors.initials: AF
authors.lastname: Grootendorst
authors.forename: E F
authors.initials: EF
authors.lastname: van Bommel
authors.forename: L A
authors.initials: LA
authors.lastname: van Leengoed
authors.forename: M
authors.initials: M
authors.lastname: Nabuurs
authors.forename: C S
authors.initials: CS
authors.lastname: Bouman
authors.forename: A B
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D000818:Animals; D006439:Hemodynamics; D006440:Hemofiltration; D007422:Intestines / Q000098:blood supply* / Q000473:pathology; D007511:Ischemia / Q000401:mortality / Q000503:physiopathology*; D008638:Mesenteric Arteries / Q000503:physiopathology; D015427:Reperfusion Injury / Q000401:mortality / Q000503:physiopathology*; D015996:Survival Rate; D013552:Swine