Benefits of an early cooling phase in continuous renal replacement therapy for ICU patients
Lowering the temperature setting in the heating device during continuous venovenous hemofiltration (CVVH) is an option. The purpose of this study was to determine the effects on body temperature and hemodynamic tolerance of two different temperature settings in the warming device in patients treated with CVVH.
Thirty patients (mean age: 66.5 years; mean SAPS 2: 55) were enrolled in a prospective crossover randomized study. After a baseline of 2 h at 38°C, the heating device was randomly set to 38°C (group A) and 36°C (group B) for 6 h. Then, the temperatures were switched to 36°C in group A and to 38°C in group B for another 6 h. Hemodynamic parameters and therapeutic interventions to control the hemodynamics were recorded.
There was no significant change in body temperature in either group. During the first 6 h, group B patients showed significantly increased arterial pressure (p = 0.01) while the dosage of catecholamine was significantly decreased (p = 0.04). The number of patients who required fluid infusion or increase in catecholamine dosage was similar. During the second period of the study, hemodynamic parameters were unchanged in both groups.
In patients undergoing CVVH, warming of the substitute over 36°C had no impact on body temperature. We showed that setting the fluid temperature at 36°C for a period of time early in the procedure is beneficial in terms of increased mean arterial pressure and decreased catecholamine infusion dosage.
- Maggiore, Q, Pizzarelli, F, Zoccali, C, Sisca, S, Nicolò, F, Parlongo, S (1981) Effect of extracorporeal blood cooling on dialytic arterial hypotension. Proc Eur Dial Transplant Assoc 18: pp. 597-602
- Van, K, Luik, AJ, De Leew, PW, Van Hooff, JP, Nieman, FH, Habets, HM, Leunissen, KM (1995) Vascular reactivity during hemodialysis and isolated ultrafiltration: thermal influences. Nephrol Dial Transplant 10: pp. 1852-1858
- Maggiore, Q, Pizzarelli, F, Santoro, A, Panzetta, G, Bonforte, G, Hannedouche, T, De Lara, MAA, Tsouras, I, Loueiro, A, Ponce, P, Sulkova, S, Van Rooste, G, Brink, H, Kwan, JT (2002) The effects of control thermal balance on vascular stability in hemodialysis patients: results of the European randomised clinical trial. Am J Kidney Dis 40: pp. 280-290 CrossRef
- Van Der Sande, FM, Kooman, JP, Konings, CJ, Leunissen, KM (2001) Thermal effects and blood pressure response during post-dilution hemofiltration and hemodialysis: the effect of amount of replacement fluid and dialysate temperature. J Am Soc Nephrol 12: pp. 1916-1920
- Selby, NM, McIntyre, CW (2006) A systematic review of the clinical effects of reducing dialysate fluid temperature. Nephrol Dial Transplant 21: pp. 1883-1898 CrossRef
- Schorguen, F, Soubrier, N, Delclaux, C, Thuong, M, Giropu, E, Brun-Buisson, C, Lemaire, F, Brochard, L (2000) Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: Usefulness of practice guidelines. Am J Respir Crit Care Med 162: pp. 197-202
- Manns, M, Maurer, E, Steinbach, B, Evering, HG (1998) Thermal energy balance duringin vitrocontinuous veno-venous hemofiltration. ASAIO J 44: pp. M601-M605 CrossRef
- Nunnally, ME, Jaeschke, R, Bellingan, GJ, Lacroix, J, Mourvillier, B, Rodriguez-Vega, GM, Rubertsson, S, Vassilakopoulos, T, Weinert, C, Zanotti-Cavazzoni, S, Buchman, TG (2011) International consensus conference: Targeted Temperature Management in Critical Care: A Report and Recommendations from Five Professional. Societies Crit Care Med 39: pp. 1113-1125 CrossRef
- Sessler, DI (2008) Temperature monitoring and perioperative thermoregulation. Anesthesiology 109: pp. 318-338 CrossRef
- Rogiers, P, Sun, Q, Dimopoulos, G, Tu, Z, Pauwels, D, Manhaeghe, C, Su, F, Vincent, JL (2006) Blood warming during hemofiltration can improve hemodynamics and outcome in ovine septic shock. Anesthesiology 104: pp. 1216-1222 CrossRef
- Van Kuijk, WHM, Hillion, D, Savoiu, C, Leunissen, KM (1997) Critical role of the extracorporeal blood temperature in the hemodynamic response during hemofiltration. J Am Soc Nephrol 8: pp. 949-955
- Donauer, J, Schweiger, C, Rumberger, B, Rumberger, B, Krumme, B, Böhler, J (2003) Reduction of hypotensive side effects during online-haemodiafiltration and low temperature haemodialysis. Nephrol Dial Transplant 18: pp. 1616-1622 CrossRef
- Altieri, P, Sorba, G, Bolasco, P, Ledebo, I, Ganadu, M, Ferrara, R, Menneas, A, Asproni, E, Casu, D, Passaghe, M, Sau, G, Cadinu, F (2004) Comparison between hemofiltration and hemodiafiltration in a long-term prospective cross-over study. J Nephrol 17: pp. 414-422
- Manthous, CA, Hall, JB, Olson, D, Singh, M, Chatila, W, Pohlman, A, Kushner, R, Schmidt, GA, Wood, LD (1995) Effect of cooling on oxygen consumption in febrile critically ill patients. Am J Respir Crit Care Med 151: pp. 10-14
- Matamis, D, Tsagourias, M, Koletos, K, Riggos, D, Mavromatidis, K, Sombolos, K, Bursztein, S (1994) Influence of continuous haemofiltration-related hypothermia on hemodynamic variables and gas exchange in septic patients. Intensive Care Med 20: pp. 431-436 CrossRef
- Yagi, A, Leblanc, C, Sakai, K, Wright, EJ, Paganini, EP (1998) Cooling effect of continuous renal replacement therapy in critically ill patients. Am J Kidney Dis 32: pp. 1023-1030 CrossRef
- Rokyta, R, Matejovic, M, Krouzecky, A, Opatrny, K, Ruzicka, J, Novak, I (2004) Effects of continuous venovenous haemofiltration-induced cooling on global haemodynamics, splanchnic oxygen and energy balance in critically ill patients. Nephrol Dial Transplant 19: pp. 623-630 CrossRef
- Pizzarelli, F (2007) From cold dialysis to isothermic dialysis: a twenty-five year voyage. Nephrol Dialysis Transplant 22: pp. 1007-1012 CrossRef
- Krouzecky, A, Chvojka, J, Sykora, R, Radej, J, Karvunidis, T, Novak, I, Ruzicka, J, Petrankova, Z, Benes, J, Bolek, L, Matejovic, M (2009) Regional cooling of the extracorporeal blood circuit: a novel anticoagulation approach for renal replacement therapy. Intensive Care Med 35: pp. 364-370 CrossRef
- Moran, JL, Peter, JV, Solomon, PJ, Grealy, B, Smith, T, Ashforth, W, Wake, M, Peake, SL, Peisach, AR (2007) Tympanic temperature measurements: are they reliable in the critically ill? A clinical study of measures of agreement. Crit Care Med 35: pp. 155-164 CrossRef
- Benefits of an early cooling phase in continuous renal replacement therapy for ICU patients
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Annals of Intensive Care
- Online Date
- August 2012
- Online ISSN
- Additional Links
- Renal replacement therapy
- Rewarming device
- Author Affiliations
- 1. Department of Critical Care Medicine, University of Poitiers, CHU, Poitiers, F86000, France
- 2. INSERM Unit U1082, University of Poitiers, CHU, Poitiers, F86000, France
- 5. Service de Réanimation Médicale, CHU Poitiers, Hôpital Jean Bernard, Poitiers Cedex, 86021, France
- 3. Department of Anesthesiology, Centre Hospitalier de Pau, Pau, F64000, France
- 4. INSERM ERI 23, University of Poitiers, CHU, Poitiers, F86000, France