Cytokine removal and cardiovascular hemodynamics in septic patients with continuous venovenous hemofiltration

摘要: Objectives: To determine whether continuous venovenous hemofiltration leads to extraction of tumor necrosis factor alpha (TNFα) and cytokines from the circulation critically ill patients with sepsis acute renal failure quantitate clearance removal rate these their effect on serum cytokine concentrations. Design: Prospective, controlled study in (24 l/24 h) using a polysulphone membrane failure. Patients: 33 ventilated septic (n = 18) cardiovascular origin 15) were studied. Interventions: Hemodynamic monitoring collection blood ultrafiltrate samples before during first 72 h hemofiltration. Measurements main results: Cardiovascular hemodynamics (Swan-Ganz catheter), Acute Physiology Chronic Health Evaluation II score, creatinine, electrolytes, urea nitrogen recorded daily. Cytokines (TNFα, TNFα-RII, interleukin (IL) 1β , IL1RA, IL2, IL2R, IL6, IL6R, IL8, IL10) measured prefilter immediately preceding 12, 24, 48, after initiating (CVVH). Septic showed elevated values for cardiac output (7.2 ± 2.1 l/min), index (4.2 1.3 l/min per m2), stroke volume (67 23 ml) reduced systemic vascular resistance (540 299 dyn · s cm− 5). All hemodynamic normalized within 24 CVVH treatment. TNFα was 1833 1217 pg/ml 42.9 6.3 nonseptic (p < 0.05) prior CVVH. detected but did not decrease treatment There no difference IL between (3.8 1.9 pg/ml) (1.7 0.5 pg/ml). No significant elimination achieved present by Conclusions: These findings demonstrate that can remove special patients. seemed improve induction treatment, although there evidence extracorporeal reduction levels. The indicates low membranes is able induce cytokines.