Erschienen in:
01.05.2006 | Original
High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock
verfasst von:
Rodrigo Cornejo, Patricio Downey, Ricardo Castro, Carlos Romero, Tomas Regueira, Jorge Vega, Luis Castillo, Max Andresen, Alberto Dougnac, Guillermo Bugedo, Glenn Hernandez
Erschienen in:
Intensive Care Medicine
|
Ausgabe 5/2006
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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.