Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock
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The objective was to examine the effect of repeated applications of coupled plasmafiltration-adsorption on the hemodynamic response in septic shock patients hospitalized in intensive care units (ICUs).
General ICU of a tertiary care, non-teaching, 400-bed, city hospital.
Patients and participants
Twelve consecutive mechanically ventilated septic shock patients, with or without concomitant acute renal failure (ARF).
A median of 10 consecutive sessions (prescribed treatment time: 10 h/session; delivered duration: 8.43±1.37 h/min) of coupled plasmafiltration-adsorption for each patient.
Measurements and results
Mean arterial pressure (77.2±12.5 [CI 95%; 74.5–79.8] vs. 83.3±14.1 [CI 95%; 80.3–86.3] mm Hg; [p<0.001]), cardiac index (4.03±0.89 [CI 95%; 3.83–4.22] vs. 3.46±0.82 [CI 95%; 3.28–3.64] L/m2/min; [p<0.001]), systemic vascular resistance index (1,388±496 [CI 95%; 1,278–1,497] vs. 1,753±516 [CI 95%; 1,639–1,867] dynes × s/cm5; [p<0.001]), PO2/FIO2 ratio (204±87 [CI 95%; 185–223] vs. 238±82 [CI 95%; 220–256]; [p<0.001]), significantly improved during 100 global treatments (pre- vs. post-treatment values). Intra-thoracic blood volume and extra-vascular lung water did not change across treatments. Vasopressor requirement was reduced: norepinephrine decrease from an infusion rate of 0.13±0.07 (CI 95%; 0.06–0.16) to 0 γ/kg/min after a mean of 5.3±2.7 sessions. C reactive protein (CRP) significantly decreased (from 29.3±7.3 vs. 7.9±4.8; p<0.0001) during treatment. Survival was 90% at day 28 and 70% at day 90.
Coupled plasmafiltration-adsorption was a feasible and safe extracorporeal treatment and exerted a remarkable improvement in the hemodynamics, the pulmonary function, and the outcome in septic shock patients with or without concomitant ARF.
KeywordsSeptic shock Multi organ dysfunction syndrome Plasmafiltration Adsorption Hemodynamics Acute renal failure
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