Arterio- and veno-venosus hemofiltration in the treatment of sepsis and septic shock

Many inflammatory agents are known to be released in huge quantities in septic shock. The level of the agents could be decreased by the continuous arterio-, and veno-venosus hemofiltration (CAVH and CVVH).

Our study was conducted to remove the inflammatory mediators from the circulation by the assistance of the CAVH and the control of the hemodynamic stability.

Method

Forty-eight patients was applied on the study. The hemodynamic parameters were measured with the thermodilution technique. The mean arterial pressure (MAP), the pulse (F), the cardiac output (CO), the pulmonary wedge pressure (PCWP), the systemic vascular resistance (SVR), the left and right ventricule work-index (LVSWI, RVSWI) were measured, The oxygen delivery and consumption (DO₂, VO₂), the serum lactate level were estimated. The inflammatory parameters - C-reactive protein, procalcitonin, white blood cell - were controlled daily. The laboratory tests of fluid balance and inonogram (Na, K in the urine), the clinical signs (temperature, consciousness, APACHE II score) were assessed daily.

Results

The hemodynamic parameters were stable: CO: 9.6-7.8 l/min, SVR: 541-789 dyns cm^-5, the tissue oxygenation was improved (DO₂ 7.5-16.7 ml/min/kg, VO₂ 1.24-3.4 ml/min/kg). The temperature of patients were decreased (39.2-37.4°C), the urine increased (22.4-43.5 ml/kg/die), the APACHE II score decreased (28.4-19.7) and the GCS (7.8-11.4) increased. The inflammatory parameters were on the normal level after 2 days of the CAVH (CRP: 261-61. PCT: 10-0.5 ng/ml).

The hemodynamic effect of the CAVH or CVVH was favourable, the heart function was improved, the fluid-, and ion-balance could have been controlled well.