title: Relative Blood Volume Monitoring during Renal  Replacement Therapy in Critically Ill Patients with  Septic Shock: A Preliminary Report.
abstract: BACKGROUND
  Volume management during renal replacement therapy (RRT) in septic shock is always in the conflict between aggravating hypovolemia by undue ultrafiltration (UF) and insufficient reduction of fluid overload which is associated with adverse outcome. Relative blood volume (RBV) monitoring could be helpful for timely transition from fluid resuscitation to fluid removal.
  
  
  METHODS
  Data of RBV were continuously monitored and used for guidance of UF and fluid resuscitation in 21 consecutive patients with severe septic multiple organ failure. RRT was applied with extended daily hemodiafiltration for median 11 h (range 6-23). Changes in RBV were analyzed during the first 4 treatment sessions.
  
  
  RESULTS
  During 26 treatments, RBV monitoring revealed an internal volume loss substituted by a median infusion volume of 2.38 l (maximum 8.07 l) per treatment to keep the RBV constant. In the remaining 40 sessions, a median net-UF of 1.00 l (range 0.40-4.40) was achieved. In the first 2 days predominantly substitution was necessary whereas from the third day UF became increasingly possible. The 28-day survival rate was 81%.
  
  
  CONCLUSIONS
  Blood volume monitoring proved to be an easy and feasible tool for safe guidance of fluid management maintaining the balance between UF and vascular refilling. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=433415
authors.forename: Susanne
authors.initials: S
authors.lastname: Kron
authors.forename: Til
authors.initials: T
authors.lastname: Leimbach
authors.forename: Reinhard
authors.initials: R
authors.lastname: Wenkel
authors.forename: Ulrike
authors.initials: U
authors.lastname: Thieme
authors.forename: Hartmut
authors.initials: H
authors.lastname: Kern
authors.forename: Joachim
authors.initials: J
authors.lastname: Kron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D016638:Critical Illness; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D017583:Hemodiafiltration; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate