[Effect of continuous high-volume hemofiltration on patients with acute respiratory distress syndrome and multiple organ dysfunction syndrome].
OBJECTIVE
To investigate the effect of continuous high-volume hemofiltration (HVHF) on extravascular lung water and respiratory mechanics in patients with acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS).


METHODS
Forty-one patients with ARDS and MODS were randomized into control group (20 patients) and HVHF treatment group (21 patients). The patients in HVHF treatment group undergoing mechanical ventilation were treated with HVHF (6 L/h) for 24 hours. The pulse indicator continuous cardiac output (PiCCO) catheter was inserted for monitoring cardiac output (CO), the extravascular lung water index (EVLWI) and intrathoracic blood volume index (ITBVI). Arterial partial pressure of oxygen (PaO(2)), arterial partial pressure of carbon dioxide (PaCO(2)), oxygenation index (PaO(2)/FiO(2)), peak airway pressure (Ppeak) and dynamic compliance (Cdyn) were measured. Concentrations of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in blood were detected by enzyme linked immunosorbent assay (ELISA).


RESULTS
All indexes in control group did not show significant improvement before and after treatment (all P>0.05). There was significant lowering of concentrations of TNF-alpha and IL-6 in blood after HVHF at 24 hours, and also true in CO and EVLWI (all P<0.05). Ppeak and Cdyn were improved significantly, PaO(2)/FiO(2) increased markedly, and compared with that before HVHF and control group, significant differences were found in all the indexes (all P<0.05).


CONCLUSIONS
HVHF shows significant beneficial effects on pulmonary function of patients with ARDS and MODS as a result of removal of cytokines, decrease in EVLWI and amelioration of disturbance in oxygen metabolism.
Xie
Jian
J
Intensive Care Unit, Qianfoshan Hospital, Jinan 250014, Shandong, China. xiejian2509@sina.com
Yang
Jun
J
D000368:Aged; D000369:Aged, 80 and over; D015633:Extravascular Lung Water; D005260:Female; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008170:Lung Compliance; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha