title: High-volume hemofiltration as adjuvant therapy for refractory shock after pericardiocentesis.
abstract: BACKGROUND
  Pericardiocentesis for the treatment of chronic cardiac tamponade can occasionally result in acute pulmonary edema or biventricular failure. A sudden increase in heart filling pressures and right-to-left ventricular-output mismatch have been proposed underlying mechanisms.
  
  
  METHODS
  We report the case of 16-year-old patient who underwent pericardiocentesis for chronic cardiac tamponade 6 weeks after undergoing a Bentall procedure. The patient developed circulatory shock 6 hours after pericardiocentesis. High-volume hemofiltration was used as a rescue therapy after treatment with positive inotropic drugs proved ineffective. An improvement in circulatory function observed after commencement of the hemofiltration treatment was followed by hemodynamic deterioration when the hemofiltration procedure was ceased.
  
  
  CONCLUSIONS
  The mechanism of the observed hemodynamic improvement is unclear. Hemodynamic recovery related in time to high-volume hemofiltration treatment indicates the possible removal of inflammatory mediators. Visceral vasoconstriction resulting from cardiac tamponade and subsequent improvement in gut perfusion after pericardiocentesis that led to washout of inflammatory mediators might have contributed to the development of acute heart failure. Cytokine removal by high-volume hemofiltration and the procedure's relationship to hemodynamic improvement have previously been demonstrated in clinical and experimental studies of septic shock.
  
  
  CONCLUSIONS
  We conclude that high-volume hemofiltration can be helpful as an adjuvant treatment for refractory shock after pericardiocentesis for chronic cardiac tamponade. The mechanism of the observed hemodynamic improvement remains to be investigated.
authors: Department of Cardiac Anesthesiology, Medical University of Gdansk, Gdansk, Poland. rlango@gumed.edu.pl
authors: Romuald
authors: R
authors: Lango
authors: Maciej M
authors: MM
authors: Kowalik
authors: Piotr
authors: P
authors: Siondalski
authors: Jan
authors: J
authors: Rogowski
authors: Alicja
authors: A
authors: Dabrowska-Kugacka
mesh_terms: D000293:Adolescent; D002305:Cardiac Tamponade / Q000601:surgery*; D004452:Echocardiography; D006352:Heart Ventricles; D006439:Hemodynamics; D006440:Hemofiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008382:Marfan Syndrome; D020519:Pericardiocentesis / Q000009:adverse effects*; D012769:Shock / Q000628:therapy*