title: Effects of high volume haemodiafiltration on inflammatory response profile and microcirculation in patients with septic shock.
abstract: BACKGROUND
  High volumes of haemofiltration are used in septic patients to control systemic inflammation and improve patient outcomes. We aimed to clarify if extended intermittent high volume online haemodiafiltration (HVHDF) influences patient haemodynamics and cytokines profile and/or has effect upon sublingual microcirculation in critically ill septic shock patients.
  
  
  METHODS
  Main haemodynamic and clinical variables and concentrations of cytokines were evaluated before and after HVHDF in 19 patients with septic shock requiring renal replacement therapy due to acute kidney injury. Sublingual microcirculation was assessed in 9 patients.
  
  
  RESULTS
  The mean (SD) time of HVHDF was 9.4 (1.8) hours. The median convective volume was 123 mL/kg/h. The mean (SD) dose of norepinephrine required to maintain mean arterial pressure at the target range of 70-80 mmHg decreased from 0.40 (0.43) μg/kg/min to 0.28 (0.33) μg/kg/min (p = 0.009). No significant changes in the measured cytokines or microcirculatory parameters were observed before and after HVHDF.
  
  
  CONCLUSIONS
  The single-centre study suggests that extended HVHDF results in decrease of norepinephrine requirement in patients with septic shock. Haemodynamic improvement was not associated with decrease in circulating cytokine levels, and sublingual microcirculation was well preserved.
authors.affiliation: Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia ; Department of Anaesthesiology and Intensive Care, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Kadri
authors.initials: K
authors.lastname: Tamme
authors.affiliation: Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia ; Department of Anaesthesiology and Intensive Care, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Liivi
authors.identifier: 0000-0003-3553-5083
authors.initials: L
authors.lastname: Maddison
authors.affiliation: Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Rein
authors.initials: R
authors.lastname: Kruusat
authors.affiliation: Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Hans-Erik
authors.initials: HE
authors.lastname: Ehrlich
authors.affiliation: Department of Anaesthesiology and Intensive Care, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Viirelaid
authors.affiliation: Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia ; Department of Anaesthesiology and Intensive Care, DRK Kliniken, Berlin, Salvador-Allende Strasse 2-8, Köpenick, 12559 Berlin, Germany.
authors.forename: Hartmut
authors.identifier: 0000-0002-1114-1066
authors.initials: H
authors.lastname: Kern
authors.affiliation: Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia ; Department of Anaesthesiology and Intensive Care, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia.
authors.forename: Joel
authors.identifier: 0000-0003-4321-3287
authors.initials: J
authors.lastname: Starkopf
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D016207:Cytokines / Q000097:blood; D005260:Female; D017583:Hemodiafiltration / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply; D009638:Norepinephrine / Q000008:administration & dosage; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*
chemical_list: D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators; D009638:Norepinephrine