High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock.
OBJECTIVE
To evaluate the effect of short-term (12-h) high-volume hemofiltration (HVHF) in reversing progressive refractory hypotension and hypoperfusion in patients with severe hyperdynamic septic shock. To evaluate feasibility and tolerance and to compare observed vs. expected hospital mortality.


METHODS
Prospective, interventional, nonrandomized study in the surgical-medical intensive care unit of an academic tertiary center.


METHODS
Twenty patients with severe septic shock, previously unresponsive to a multi-intervention approach within a goal-directed, norepinephrine-based algorithm, with increasing norepinephrine (NE) requirements (>0.3 microg kg(-1) min(-1)) and lactic acidosis.


METHODS
Single session of 12-h HVHF.


RESULTS
We measured changes in NE requirements and perfusion parameters every 4h during HVHF and 6h thereafter. Eleven patients showed decreased NE requirements and lactate levels (responders). Nine patients did not fulfill these criteria (nonresponders). The NE dose, lactate levels, and heart rates decreased and arterial pH increased significantly in responders. Hospital mortality (40%) was significantly lower than predicted (60%): 67% (6/9) in nonresponders vs. 18% (2/11) in responders. Of 12 survivors 7 required only a single 12-h HVHF session. On logistic regression analysis the only statistically significant predictor of survival was theresponse to HVHF (odds ratio 9).


CONCLUSIONS
A single session of HVHF as salvage therapy in the setting of a goal-directed hemodynamic management algorithm may be beneficial in severe refractory hyperdynamic septic-shock patients. This approach may improve hemodynamics and perfusion parameters, acid-base status, and ultimately hospital survival. Moreover, it is feasible, and safe.
Cornejo
Rodrigo
R
Intensive Care Medicine, Catholic University of Chile, Marcoleta 367 Tercer Piso, Santiago Centro, Chile.
Downey
Patricio
P
Castro
Ricardo
R
Romero
Carlos
C
Regueira
Tomas
T
Vega
Jorge
J
Castillo
Luis
L
Andresen
Max
M
Dougnac
Alberto
A
Bugedo
Guillermo
G
Hernandez
Glenn
G
D000328:Adult; D000368:Aged; D000465:Algorithms; D002677:Chile; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy / Q000379:methods*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000503:physiopathology*