Continuous hemofiltration in hyperthermic septic shock patients.
BACKGROUND
Severe hyperthermia commonly accompanies septic shock. High body temperature in absence of infection activates the inflammatory response and is associated with a high mortality. Three years ago, our hypothesis that sustained fever is harmful in septic shock led us to the development of a protocol aiming at decreasing hyperthermia (>/=39.5 degrees C) by means of hemofiltration when the patients did not respond to antipyretics. We present a report of temperature and hemodynamic changes and the outcome of 19 consecutive hyperthermic septic shock patients with multiorgan system failure and compare them with a historical similar group of patients in whom hyperthermia was not treated with hemofiltration.


METHODS
Depending on renal function, patients were treated with continuous low-flow hemofiltration (n = 8) or hemodiafiltration, (n = 11). Core temperature was registered every hour. A hemodynamic index (HI) was defined (mean arterial pressure to noradrenaline dose) and used during the first 24 hours to describe the patients' hemodynamic profile by means of its percent variation starting 6 hours before instituting the hemofiltration.


RESULTS
The patients' temperature decreased linearly from 39.8 degrees C +/- 0.5 degrees C before hemofiltration to 37 degrees C +/- 1.2 degrees C after 24 hours of treatment (p < 0.001). The HI decreased significantly from -6 hours to the onset of hemofiltration (p = 0.002) and increased significantly after 24 hours (p = 0.008). Twenty-eight-day mortality was 32% (6 of 19) when compared with 100% (11 of 11) in the historical group (p < 0.001).


CONCLUSIONS
Continuous low-flow hemofiltration decreased body temperature and vasopressor requirements in hyperthermic septic shock patients. The mortality was unexpectedly low.
Pestaña
David
D
Servicio de Anestesia-Reanimación, Residencia General, Hospital Universitario La Paz, Madrid, Spain. dpestana.hulp@salud.madrid.org
Casanova
Elena
E
Villagrán
María J
MJ
Tormo
Carolina
C
Pérez-Chrzanowska
Hanna
H
Redondo
Javier
J
Caldera
María V
MV
Royo
Concepción
C
D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001831:Body Temperature; D005260:Female; D005334:Fever / Q000209:etiology* / Q000628:therapy*; D006440:Hemofiltration; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone