title: Haemodynamics in leptospirosis: effects of plasmapheresis and continuous venovenous haemofiltration.
abstract: BACKGROUND
  Haemodynamics in leptospirosis may differ from that of sepsis because of frequently obeserved myocarditis and severe cholestatic jaundice. A haemodynamic study was therefore made in 10 patients with severe leptospirosis.
  
  
  RESULTS
  All patients had pulmonary complications with a chest X-ray showing either pulmonary oedema or infiltration. Renal failure was present in nine patients. Three patterns of haemodynamics were revealed. The first pattern was observed in six patients who showed increased cardiac index, decreased systemic vascular resistance, normal pulmonary capillary wedge pressure, normal pulmonary vascular resistance and hypotension. The pattern resembled that of sepsis. The second pattern shown in two patients with haemoptysis consisted of a normal cardiac index, normal systemic vascular resistance, normal blood pressure, normal pulmonary capillary wedge pressure and increased pulmonary vascular resistance. The third pattern was observed in two patients with severe jaundice who had hypotension, a relatively low cardiac index, increased systemic vascular resistance and normal pulmonary capillary wedge pressure, and pulmonary vascular resistance. Plasmapheresis performed in two patients and continuous venovenous haemofiltration performed in two patients improved systemic haemodynamics and normalized blood pressure with a resolution of lung signs.
authors.affiliation: Department of Medicine, Maharaj Nakhonratchasima Hospital, Nakhonratchasima, Thailand.
authors.forename: Tongprakob
authors.initials: T
authors.lastname: Siriwanij
authors.forename: Chuanpit
authors.initials: C
authors.lastname: Suttinont
authors.forename: Terapong
authors.initials: T
authors.lastname: Tantawichien
authors.forename: Sauwaluck
authors.initials: S
authors.lastname: Chusil
authors.forename: Talerngsak
authors.initials: T
authors.lastname: Kanjanabuch
authors.forename: Visith
authors.initials: V
authors.lastname: Sitprija
mesh_terms: D000328:Adult; D001794:Blood Pressure; D005260:Female; D006440:Hemofiltration; D006801:Humans; D007022:Hypotension / Q000382:microbiology / Q000503:physiopathology; D007922:Leptospirosis / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011669:Pulmonary Wedge Pressure; D014655:Vascular Resistance