High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?
OBJECTIVE
The role of haemofiltration as an adjunctive treatment of sepsis remains a contentious issue. To address the role of dose and to explore the biological effects of haemofiltration we compared the effects of standard and high-volume haemofiltration (HVHF) in a peritonitis-induced model of porcine septic shock.


METHODS
Randomized, controlled experimental study.


METHODS
Twenty-one anesthetized and mechanically ventilated pigs.


METHODS
After 12 h of hyperdynamic peritonitis, animals were randomized to receive either supportive treatment (Control, n = 7) or standard haemofiltration (HF 35 ml/kg per h, n = 7) or HVHF (100 ml/kg per hour, n = 7).


RESULTS
Systemic and hepatosplanchnic haemodynamics, oxygen exchange, energy metabolism (lactate/pyruvate, ketone body ratios), ileal and renal cortex microcirculation and systemic inflammation (TNF-alpha, IL-6), nitrosative/oxidative stress (TBARS, nitrates, GSH/GSSG) and endothelial/coagulation dysfunction (von Willebrand factor, asymmetric dimethylarginine, platelet count) were assessed before, 12, 18, and 22 h of peritonitis. Although fewer haemofiltration-treated animals required noradrenaline support (86, 43 and 29% animals in the control, HF and HVHF groups, respectively), neither of haemofiltration doses reversed hyperdynamic circulation, lung dysfunction and ameliorated alterations in gut and kidney microvascular perfusion. Both HF and HVHF failed to attenuate sepsis-induced alterations in surrogate markers of cellular energetics, nitrosative/oxidative stress, endothelial injury or systemic inflammation.


CONCLUSIONS
In this porcine model of septic shock early HVHF proved superior in preventing the development of septic hypotension. However, neither of haemofiltration doses was capable of reversing the progressive disturbances in microvascular, metabolic, endothelial and lung function, at least within the timeframe of the study and severity of the model.
ICU, 1st Medical Department, Charles University Medical School and Teaching Hospital Plzen, Alej svobody 80, 304 60, Plzen, Czech Republic.
Roman
R
Sykora
Jiri
J
Chvojka
Ales
A
Krouzecky
Jaroslav
J
Radej
Thomas
T
Karvunidis
Veronika
V
Varnerova
Ivan
I
Novak
Martin
M
Matejovic
D000818:Animals; D018450:Disease Progression; D004734:Energy Metabolism; D006439:Hemodynamics / Q000502:physiology*; D006440:Hemofiltration / Q000379:methods*; D008833:Microcirculation / Q000502:physiology; D018384:Oxidative Stress / Q000502:physiology; D010538:Peritonitis / Q000150:complications* / Q000503:physiopathology*; D011897:Random Allocation; D012772:Shock, Septic / Q000209:etiology* / Q000628:therapy*; D013552:Swine