Amelioration of hemodynamics and oxygen metabolism by continuous venovenous hemofiltration in experimental porcine pancreatitis.
OBJECTIVE
To investigate the potential role of continuous venovenous hemofiltration (CVVH) in hemodynamics and oxygen metabolism in pigs with severe acute pancreatitis (SAP).


METHODS
SAP model was produced by intraductal injection of sodium taurocholate (4%, 1 mL/kg body weight (BW)) and trypsin (2 U/kg BW). Animals were allocated either to untreated controls as group 1 or to one of two treatment groups as group 2 receiving a low-volume CVVH (20 mL/(kg.h)), and group 3 receiving a high-volume CVVH (100 (mL/kg.h)). Swan-Ganz catheter was inserted during the operation. Heart rate, arterial blood pressure, cardiac output, mean pulmonary arterial pressure, pulmonary arterial wedge pressure, central venous pressure, systemic vascular resistance, oxygen delivery, oxygen consumption, oxygen extraction ratio, as well as survival of pigs were evaluated in the study.


RESULTS
Survival time was significantly prolonged by low-volume and high-volume CVVHs, which was more pronounced in the latter. High-volume CVVH was significantly superior compared with less intensive treatment modalities (low-volume CVVH) in systemic inflammatory reaction protection. The major hemodynamic finding was that pancreatitis-induced hypotension was significantly attenuated by intensive CVVH (87.4+/-12.5 kPa vs 116.3+/-7.8 kPa, P<0.01). The development of hyperdynamic circulatory failure was simultaneously attenuated, as reflected by a limited increase in cardiac output, an attenuated decrease in systemic vascular resistance and an elevation in oxygen extraction ratio.


CONCLUSIONS
CVVH blunts the pancreatitis-induced cardiovascular response and increases tissue oxygen extraction. The high-volume CVVH is distinctly superior in preventing sepsis-related hemodynamic impairment.
Wang
Hao
H
Department of Nephrology, Nanjing University School of Medicine, Nanjing, Jiangsu Province, China.
Zhang
Zhen-Huan
ZH
Yan
Xiao-Wen
XW
Li
Wei-Qin
WQ
Ji
Da-Xi
DX
Quan
Zhu-Fu
ZF
Gong
De-Hua
DH
Li
Ning
N
Li
Jie-Shou
JS
D000208:Acute Disease; D000681:Amylases / Q000097:blood; D000818:Animals; D001794:Blood Pressure; D002496:Central Venous Pressure; D006440:Hemofiltration; D009102:Multiple Organ Failure / Q000517:prevention & control; D010101:Oxygen Consumption; D010195:Pancreatitis / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D034421:Sus scrofa
D000681:Amylases