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Intensive Care Medicine

, Volume 32, Issue 5, pp 713–722 | Cite as

High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock

  • Rodrigo Cornejo
  • Patricio Downey
  • Ricardo Castro
  • Carlos Romero
  • Tomas Regueira
  • Jorge Vega
  • Luis Castillo
  • Max Andresen
  • Alberto Dougnac
  • Guillermo Bugedo
  • Glenn Hernandez
Original

Abstract

Objectives

To evaluate the effect of short-term (12-h) high-volume hemofiltration (HVHF) in reversing progressive refractory hypotension and hypoperfusion in patients with severe hyperdynamic septic shock. To evaluate feasibility and tolerance and to compare observed vs. expected hospital mortality.

Design and setting

Prospective, interventional, nonrandomized study in the surgical-medical intensive care unit of an academic tertiary center.

Patients

Twenty patients with severe septic shock, previously unresponsive to a multi-intervention approach within a goal-directed, norepinephrine-based algorithm, with increasing norepinephrine (NE) requirements (> 0.3 μg kg–1 min–1) and lactic acidosis.

Interventions

Single session of 12-h HVHF.

Measurements and results

We measured changes in NE requirements and perfusion parameters every 4 h during HVHF and 6 h thereafter. Eleven patients showed decreased NE requirements and lactate levels (responders). Nine patients did not fulfill these criteria (nonresponders). The NE dose, lactate levels, and heart rates decreased and arterial pH increased significantly in responders. Hospital mortality (40%) was significantly lower than predicted (60%): 67% (6/9) in nonresponders vs. 18% (2/11) in responders. Of 12 survivors 7 required only a single 12-h HVHF session. On logistic regression analysis the only statistically significant predictor of survival was theresponse to HVHF (odds ratio 9).

Conclusions

A single session of HVHF as salvage therapy in the setting of a goal-directed hemodynamic management algorithm may be beneficial in severe refractory hyperdynamic septic-shock patients. This approach may improve hemodynamics and perfusion parameters, acid-base status, and ultimately hospital survival. Moreover, it is feasible, and safe.

Keywords

Septic shock High-volume hemofiltration Algorithm norepinephrine 

Supplementary material

134_2006_118_MOESM1_ESM.doc (44 kb)
Electronic Supplementary Material (DOC 981kb)

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Rodrigo Cornejo
    • 1
  • Patricio Downey
    • 2
  • Ricardo Castro
    • 1
  • Carlos Romero
    • 1
  • Tomas Regueira
    • 1
  • Jorge Vega
    • 3
  • Luis Castillo
    • 4
  • Max Andresen
    • 4
  • Alberto Dougnac
    • 4
  • Guillermo Bugedo
    • 4
  • Glenn Hernandez
    • 4
  1. 1.Intensive Care MedicineCatholic University of ChileSantiago CentroChile
  2. 2.Department of NephrologyCatholic University of ChileSantiago CentroChile
  3. 3.School of MedicineCatholic University of ChileSantiago CentroChile
  4. 4.Department of Intensive Care Medicine and AnesthesiologyCatholic University of ChileSantiago CentroChile

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