Continuous arteriovenous hemofiltration does not improve survival in a canine model of septic shock.
BACKGROUND
We examined whether or not continuous arteriovenous hemofiltration (CAVH), in the absence of renal failure, would improve either hemodynamic abnormalities or survival in a canine model of septic shock.


METHODS
Escherichia coli 0111, as an intraperitoneal clot, was surgically implanted into 21 one- to two-year-old purpose-bred beagles. The dogs were randomized to no CAVH (control group, n = 7), sham CAVH (extracorporeal circulation without hemofiltration, n = 7), or true CAVH (hemofiltration with removal of 600 mL/hour of ultrafiltrate, n = 7). Hemofiltration began one hour after clot implantation and continued for six hours. All dogs received antibiotics and had serial hemodynamic and laboratory evaluations.


RESULTS
During the first seven hours of the study, all dogs displayed a progressive, significant decrease in mean arterial pressure, cardiac index, left ventricular ejection fraction, and serum pH (all p < 0.05). Two of seven dogs in the control group, one of seven dogs in the sham CAVH group, and one of seven dogs in the true CAVH group survived seven days after clot implantation. True CAVH, which included fluid replacement with lactated Ringer's solution, significantly increased serum lactate and decreased serum bicarbonate levels after six hours (both p < 0.05). However, pH did not differ between the three treatment groups (p > 0.20). Continuous arteriovenous hemofiltration therapy had no significant effect on cardiovascular abnormalities or survival.


CONCLUSIONS
The results of this study suggest that CAVH would be unlikely to provide benefit to patients with gram-negative septic shock, in the absence of renal failure.
Freeman
B D
BD
Critical Care Medicine Department, National Institutes of Health, Bethesda, MD 20892.
Yatsiv
I
I
Natanson
C
C
Solomon
M A
MA
Quezado
Z M
ZM
Danner
R L
RL
Banks
S M
SM
Hoffman
W D
WD
D000818:Animals; D001639:Bicarbonates / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D004195:Disease Models, Animal; D004285:Dogs; D004927:Escherichia coli Infections / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D005112:Extracorporeal Circulation; D005440:Fluid Therapy; D006440:Hemofiltration; D006863:Hydrogen-Ion Concentration; D007552:Isotonic Solutions / Q000627:therapeutic use; D007773:Lactates / Q000097:blood; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D000077325:Ringer's Lactate; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013927:Thrombosis / Q000382:microbiology; D016277:Ventricular Function, Left / Q000502:physiology
D001639:Bicarbonates; D007552:Isotonic Solutions; D007773:Lactates; D000077325:Ringer's Lactate