[Effect of high volume hemofiltration on respiration, hemodynamics and oxygen metabolism in sepsis with acute respiratory distress syndrome].
OBJECTIVE
To investigate the effect of continuous high volume hemofiltration (HVHF) on respiration, hemodynamics, and oxygen metabolism in severe sepsis patients with acute respiratory distress syndrome (ARDS).


METHODS
Twelve adult patients with ARDS received mechanical ventilation and HVHF (80 mlxkg(-1)xh(-1)) lasting 12-18 hours every day. The cardiac output (CO), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), mean pulmonary arterial pressure (MPAP), pulmonary artery wedge pressure (PAWP), arterial oxygen content (CaO(2)), O(2) content of mixed venous blood (CvO(2)), oxygen consumption (VO(2)), oxygen delivery (DO(2)) and oxygen extraction rate (O(2)ER) were measured with the aid of a Swan-Ganz catheter, the thoracic fluid content (TFC) were measured with BioZ(r) Cardio Dynamics. Concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-8 and IL-10 were measured pre-continuous HVHF and after continuous HVHF by enzyme linked immunoadsorbent assay (ELISA). Acute physiology and chronic health evaluation II (APACHEII) scores, multiple organ dysfunction syndrome (MODS) evaluation scores and PaO(2)/FiO(2) were observed before and after HVHF.


RESULTS
There were significant lowering of concentrations of TNF-alpha, IL-6 and IL-8 after HVHF at 72 hours (all P<0.05), and also in MPAP, PVR and TFC after 48 hours (all P<0.05). DO(2), VO(2) and O(2)ER were stabilized at 72 hours with amelioration of partial pressure of oxygen in artery (PaO(2)), PaO(2)/FiO(2) and peak airway pressure (Ppeak) (P<0.05 or P<0.01).


CONCLUSIONS
Continuous HVHF shows significant beneficial effects on pulmonary function of severe sepsis patients with ARDS as a result of removal of cytokines, decrease of TFC and amelioration of disturbance in respiration, hemodynamics and oxygen metabolism.
Liu
Chang-wen
CW
Department of Critical Care Medicine, the First Hospital of Hangzhou, Hangzhou 310006, Zhejiang, China. liuchangwen3048@zj.com
Zheng
Yong-ke
YK
Lu
Jun
J
Zhu
Ke-yi
KY
Hu
Wei
W
Hu
Wei-hang
WH
D000328:Adult; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
D010100:Oxygen