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Slow continuous ultrafiltration: how many fluids must be taken out?
Critical Care volume 13, Article number: P277 (2009)
Ultrafiltration (UF) is effective and safe in treating volume-overloaded patients with acute decompensated heart failure (ADHF) and diuretic resistance . Accurate determination of the amount of fluid to be removed and maintenance of the circulating blood volume are critically important . The inferior vena cava diameter (IVCD) and its collapsibility index (IVCCI) are compromised in ADHF patients due to high right atrial pressure . We hypothesized that monitoring of IVCCI could be used to optimize fluid removal rate during UF.
Twenty patients (nine male, 11 female; age 76 ± 4, New York Heart Association classes III to IV) admitted to our medical ICU for ADHF were treated with UF (Aquadex System 100; CHF Solutions, Minneapolis, MN, USA). The heart rate (HR), mean arterial pressure (MAP) and IVCD with M-mode subcostal echocardiography during spontaneous breathing were evaluated before UF (T0), at 12 hours (T1) and at 24 hours (T2). The IVCCI was calculated as follows: [(IVCDmax – IVCDmin)/IVCDmax] × 100.
The mean UF time was 25.5 ± 5 hours with a mean volume of 259 ml/hour and a total ultrafiltrate production of 6.6 ± 2 l. Differences between the T0 and T2 parameters are presented in Table 1. Hypotension was observed only in those patients (2/20) who reached IVCCI >35%. In all the other patients a significant increase in IVCCI was obtained without any hemodynamic instability.
Inferior vena cava ultrasound is a rapid, simple and noninvasive means for bedside monitoring of the intravascular volume during UF.
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Guiotto, G., Gligorova, S., Paladino, F. et al. Slow continuous ultrafiltration: how many fluids must be taken out?. Crit Care 13, P277 (2009). https://doi.org/10.1186/cc7441
- Mean Arterial Pressure
- Spontaneous Breathing
- Acute Decompensated Heart Failure
- Circulate Blood Volume
- York Heart Association Class