Early isovolaemic haemofiltration in oliguric patients with septic shock
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Objective: To evaluate the effects of early short-term, isovolaemic haemofiltration at 45 ml/kg/h on physiological and clinical outcomes in patients with septic shock. Design: Retrospective study before and after a change of unit protocol (study period 8 years). Setting: Intensive care unit of metropolitan hospital. Patients: Eighty patients with septic shock. Interventions: Introduction of a new septic shock protocol based on early isovolaemic haemofiltration (EIHF). In the pre-EIHF period (before), 40 patients received conventional supportive therapy. In the post-EIHF period (after), 40 patients received EIHF at 45 ml/kg/h of plasma-water exchange over 6 h followed by conventional continuous venovenous haemofiltration (CVVH). Anticoagulation policy remained unchanged. Measurements and main results: The two groups were comparable for age, gender and baseline APACHE II score. Delivered haemofiltration dose was above 85% of prescription in all patients. PaO2/FiO2 ratio increased from 117±59 to 240±50 in EIHF, while it changed from 125±55 to 160±50 in the control group ( p <0.05). In EIHF patients, mean arterial pressure increased (95±10 vs 60±12 mmHg; p <0.05), and norepinephrine dose decreased (0.20±2 vs 0.02±0.2 µg/kg/min; p <0.05). Among EIHF patients, 28 (70%) were successfully weaned from the ventilator compared with 15 (37%) in the control group ( p <0.01). Similarly, 28-day survival was 55% compared with 27.5% ( p <0.05). Length of stay in the ICU was 9±5 days compared with 16±4 days ( p <0.002). Conclusions: In patients with septic shock, EIHF was associated with improved gas exchange, haemodynamics, greater likelihood of successful weaning and greater 28-day survival compared with conventional therapy.
KeywordsAcute renal failure Acute respiratory distress syndrome Continuous renal replacement therapy Haemofiltration Sepsis Uraemia
We are indebted to several dedicated physicians and nurses in our ICU and Nephrology Department for their support and to Luca Marinoni for his help with data analysis and management.
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