Treatment of surgical and non-surgical septic multiorgan failure with bicarbonate hemodialysis and sequential hemofiltration
| Autor: | L. Gotloib, Roberto Fudin, A. Shostak, A. Lev, Jose Jaichenko |
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| Rok vydání: | 1995 |
| Předmět: |
Adult
Male medicine.medical_specialty Resuscitation medicine.medical_treatment Multiple Organ Failure Hemodynamics Critical Care and Intensive Care Medicine Postoperative Complications Renal Dialysis Intensive care Sepsis Hemofiltration medicine Humans Survivors Aged business.industry Septic shock Middle Aged medicine.disease Surgery Bicarbonates Blood chemistry Evaluation Studies as Topic Female Hemodialysis Complication business |
| Zdroj: | Intensive care medicine. 21(2) |
| ISSN: | 0342-4642 |
| Popis: | Hospital mortality of patients with septic multiorgan failure (MOF) is still around 95%. The present study investigates whether this high mortality could be significantly reduced by the addition of sequential hemofiltration (SH) with bicarbonate hemodialysis (HD) to the currently used life supportive measures. 35 (18 surgical and 17 nonsurgical) patients, with 3 or more organ failures, had daily sessions of zero balance SH, for periods ranging from 2–22 days. SH induced significant improvement of PaO2/100 FIO2, Apache II score, MAP, as well as blood chemistry in survivors. Dying patients had less marked improvement of blood oxygenation, non-significant changes in other variables, in addition to low MAP before and after SH, as well as marked hemodynamic unstability during the procedure. The observed hospital motality was 38% for the surgical group, and 35.3% for the medical patients (n.s.). Mortality observed in this retrospective, uncontrolled study was significantly lower than that currently observed with conventional supportive therapy, with or without the addition of other forms of blood purification, e.g. CAVH and CAVHD. This improvement in results appears to be related to the property of SH to completely clear 90% of the blood from mediators of inflammation in only one passage through the hemofilter, and to better tolerance of HD done using bicarbonate buffer. A definite evaluation of this technique will be eventually reached by a programmed, appropriate sample size study, which is out of reach for one individual ICU. |
| Databáze: | OpenAIRE |
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