Prospective evaluation of short-term, high-volume isovolemic hemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock.

摘要: OBJECTIVE To evaluate the effects of short-term, high-volume hemofiltration (STHVH) on hemodynamic and metabolic status 28-day survival in patients with refractory septic shock. DESIGN Prospective, interventional. SETTING Intensive care unit (ICU), tertiary institution. PATIENTS Twenty intractable cardiocirculatory failure complicating shock, who had failed to respond conventional therapy. INTERVENTIONS STHVH, followed by continuous venovenous hemofiltration. STHVH consisted a 4-hr period during which 35 L ultrafiltrate is removed neutral fluid balance maintained. Subsequent continued for at least 4 days. MEASUREMENTS AND MAIN RESULTS Cardiac index, systemic vascular resistance, pulmonary oxygen delivery, mixed venous saturation, arterial pH, lactate were measured serially. Fluid inotropic support managed protocol. Therapeutic endpoints as follows STHVH: a) 2 hrs, > or =50% increase cardiac index; b) =25% saturation; c) an pH >7.3; d) reduction epinephrine dose. Patients attained all four goals (11 20) considered "responders"; did not (9 "nonresponders." There no differences baseline hemodynamic, metabolic, Acute Physiology Chronic Health Evaluation Simplified Scores between responders nonresponders. Survival 28 days was better among 11 patients) than nonresponders (0 9). Factors associated hemodynamic-metabolic response status, time interval from ICU admission initiation body weight. CONCLUSIONS These data suggest that may be major therapeutic value treatment Early therapy adequate dose improve responses survival.