Hemorrhagic cardiac tamponade in critically ill patients with acute renal failure.
OBJECTIVE
The purpose of this study was to report the development, management, and follow up of tamponading uremic pericardial effusion in critically ill patients with acute renal failure.


METHODS
The setting for this study was an adult, 24-bed tertiary multidisciplinary intensive care unit (ICU) of a university hospital.


METHODS
The subjects were 5 critically ill patients with multiple organ failure including acute renal failure (ARF) that was slow to resolve.


RESULTS
Renal involvement was attributed to renal hypoperfusion, sepsis and myoglobinuria. Continuous veno-venous hemofiltration (CVVH) was instituted early during hospitalization in 4 cases and lasted for 35 to 48 days; renal replacement therapy was not used in 1 case. Tamponade developed late in the course of ARF, after CVVH was discontinued in the 4 cases and was effectively managed with percutaneous pericardiocentesis under echocardiography and continuous catheter drainage of the pericardial sac for 48 to 72 hours. Hemorrhagic fluid (Hb 2.2-5.9 g/dL) with lymphocyte predominance was detected. Transient constrictive-like pericarditis findings were present in all patients after the procedure. All patients were discharged from the hospital in a good condition with normal serum and creatinine levels; 1-year follow up showed a normal echocardiogram.


CONCLUSIONS
Awareness for the possibility of hemorrhagic pericarditis and cardiac tamponade is needed in ICU patients with ARF slow to resolve. Transient constrictive-like pericarditis may present after pericardiocentesis.
Zakynthinos
Epaminondas
E
Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece.
Theodorakopoulou
Maria
M
Daniil
Zoi
Z
Konstantinidis
Kosmas
K
Zakynthinos
Spyros
S
D058186:Acute Kidney Injury / Q000150:complications*; D000328:Adult; D002305:Cardiac Tamponade / Q000209:etiology*; D016638:Critical Illness; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology*; D010494:Pericarditis, Constrictive / Q000209:etiology; D014511:Uremia / Q000209:etiology