Early isovolaemic haemofiltration in oliguric patients with septic shock.
OBJECTIVE
To evaluate the effects of early short-term, isovolaemic haemofiltration at 45 ml/kg/h on physiological and clinical outcomes in patients with septic shock.


METHODS
Retrospective study before and after a change of unit protocol (study period 8 years).


METHODS
Intensive care unit of metropolitan hospital.


METHODS
Eighty patients with septic shock.


METHODS
Introduction of a new septic shock protocol based on early isovolaemic haemofiltration (EIHF). In the pre-EIHF period (before), 40 patients received conventional supportive therapy. In the post-EIHF period (after), 40 patients received EIHF at 45 ml/kg/h of plasma-water exchange over 6 h followed by conventional continuous venovenous haemofiltration (CVVH). Anticoagulation policy remained unchanged.


RESULTS
The two groups were comparable for age, gender and baseline APACHE II score. Delivered haemofiltration dose was above 85% of prescription in all patients. PaO2/FiO2 ratio increased from 117+/-59 to 240+/-50 in EIHF, while it changed from 125+/-55 to 160+/-50 in the control group (p<0.05). In EIHF patients, mean arterial pressure increased (95+/-10 vs 60+/-12 mmHg; p<0.05), and norepinephrine dose decreased (0.20+/-2 vs 0.02+/-0.2 microg/kg/min; p<0.05). Among EIHF patients, 28 (70%) were successfully weaned from the ventilator compared with 15 (37%) in the control group (p<0.01). Similarly, 28-day survival was 55% compared with 27.5% (p<0.05). Length of stay in the ICU was 9+/-5 days compared with 16+/-4 days (p<0.002).


CONCLUSIONS
In patients with septic shock, EIHF was associated with improved gas exchange, haemodynamics, greater likelihood of successful weaning and greater 28-day survival compared with conventional therapy.
Piccinni
Pasquale
P
Department of Anesthesiology and Intensive Care Medicine, St. Bortolo Hospital, Viale Rodolfi, 36100 Vicenza, Italy. pasquale.piccinni@ulssvicenza.it
Dan
Maurizio
M
Barbacini
Stefano
S
Carraro
Rizzieri
R
Lieta
Emanuela
E
Marafon
Silvio
S
Zamperetti
Nereo
N
Brendolan
Alessandra
A
D'Intini
Vincenzo
V
Tetta
Ciro
C
Bellomo
Rinaldo
R
Ronco
Claudio
C
D058186:Acute Kidney Injury / Q000150:complications / Q000628:therapy / Q000652:urine; D016022:Case-Control Studies; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009846:Oliguria / Q000150:complications / Q000628:therapy*; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000628:therapy / Q000652:urine; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications / Q000628:therapy* / Q000652:urine; D016019:Survival Analysis; D016896:Treatment Outcome