Systemic hemodynamic during continuous hemodiafiltration in patients with septic shock

Continuous hemodiafiltration (CHDF) is a combination of diffusion and convection mass transport effectively influencing the complex endotoxemia typical for generalized inflammation. Positive effects on systemic hemodynamics in patients with septic shock were noticed because of proinflammatory mediator elimination.

Materials and methods

Eighteen patients (11 male/seven female, mean age 47.2 ± 2.0 years) with septic shock were examined. The APACHE II score was 26.1 ± 0.6. All patients underwent mechanical lung ventilation and inotropic support. A Swan–Ganz catheter was used for monitoring of systemic hemodynamics. For the CHDF procedure we used the 'Prisma' hemoprocessor. Duration of the procedure was 73.8 ± 7.0 hours. The filtration volume was 80.4 ± 1.6 l/day.

Results

We studied retrospectively two groups: A (n = 13) and B (n = 5). At the initial stage, the mean arterial pressure was equal in both groups. At the end of the third day of treatment, we managed to discontinue inotropic support in 60% of Group A patients, whereas in Group B patients the dose of dopamine exceeded 25 μg/kg/min. The cardiac rate of Group B patients increased, accordingly. We noticed satisfied cardiac indexes (CI) in Group A: 3.49 ± 0.19–3.57 ± 0.22 l/min/m². The CI decreased from 3.14 ± 0.52 to 1.18 ± 0.49 (P < 0.01) in Group B. The CI decreases in Group B patients was accompanied by an increased systemic vascular resistance index, which was 3040.3 ± 387.3 dyns/cm⁵/m² at the end of the third day of treatment. The pulmonary vascular resistance index in Group A patients was on a subnormal level (218.1–259.9 dyns/cm⁵/m²), and in Group B increased to 621.2 ± 222.0 dyns/cm⁵/m² (P < 0.001). The same tendency we observed for the pulmonary arterial pressure and pulmonary artery wedge pressure. All patients had cardiac failure that was compensated in full for the patients Group A, and proliferated in Group B patients.

Conclusion

Early application of CHDF in patients with septic shock leads to significant improvement of systemic hemodynamics that was important for the treatment results.