title: Intermittent hemodialysis in critically ill patients with multiple organ dysfunction syndrome is associated with intestinal intramucosal acidosis.
abstract: OBJECTIVE
  Conventional intermittent hemodialysis in the critically ill patient can be associated with hemodynamic and respiratory instability. Intermittent hemodialysis induced arterial hypotension might be detrimental. We therefore studied the influence of intermittent hemodialysis on systemic and regional oxygen transport in critically ill patients.
  
  
  METHODS
  Prospective descriptive study.
  
  
  METHODS
  Medical/surgical 24-bed intensive care unit in a university hospital.
  
  
  METHODS
  Eleven critically ill patients admitted to the intensive care unit (APACHE III score: 82 +/- 12) and developing multiple organ dysfunction syndrome with acute renal failure. All patients were mechanically ventilated and hemodynamically stable with inotropic support. Systemic oxygen transport variables were calculated, and arterial blood lactate concentration was measured before, during, and after intermittent hemodialysis. Tonometer PCO2 was measured using a tonometer, and arterial-tonometer CO2 gap was used as an indicator of intestinal intramucosal acidosis.
  
  
  RESULTS
  Intermittent hemodialysis induced an increase in calculated systemic oxygen consumption (P < 0.01). During intermittent hemodialysis there was a significantly higher need of inotropic support (P < 0.05) to maintain arterial blood pressure, cardiac index, and calculated systemic arterial oxygen delivery. The arterial-tonometer CO2 gap increased significantly during and after the procedure.
  
  
  CONCLUSIONS
  In critically ill patients with multiple organ dysfunction syndrome intermittent hemodialysis induces an increase in oxygen consumption. Despite higher inotropic support to maintain systemic calculated oxygen delivery intestinal intramucosal acidosis occurs during intermittent hemodialysis and may even persist after the procedure is terminated.
authors.affiliation: Department of Intensive Care Medicine, University Hospital, University of Brussels (VUB), Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Van der Schueren
authors.forename: M
authors.initials: M
authors.lastname: Diltoer
authors.forename: M
authors.initials: M
authors.lastname: Laureys
authors.forename: L
authors.initials: L
authors.lastname: Huyghens
mesh_terms: D018806:APACHE; D000138:Acidosis / Q000209:etiology*; D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy; D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007413:Intestinal Mucosa / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000503:physiopathology* / Q000628:therapy; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018709:Statistics, Nonparametric
chemical_list: D010100:Oxygen