Early Fluid Resuscitation and High Volume Hemofiltration Decrease Septic Shock Progression in Swine

This study aimed to assess the effects of early fluid resuscitation (EFR) combined with high volume hemofiltration (HVHF) on the cardiopulmonary function and removal of inflammatory mediators in a septic shock swine model. Eighteen swine were randomized into three groups: control(n=6)(extracorporeal circulating blood only), continuous renal replacement therapy (CRRT) (n=6; ultrafiltration volume = 25 mL/Kg/h), and HVHF (n=6; ultrafiltration volume = 85 mL/Kg/h). The septic shock model was established by intravenous infusion of lipopolysaccharides (50 µg/kg/h). Hemodynamic parameters (arterial pressure, heart rate, cardiac output, stroke volume variability, left ventricular contractility, systemic vascular resistance, and central venous pressure), vasoactive drug parameters (dose and time of norepinephrine and hourly fluid intake), pulmonary function (partial oxygen pressure and vascular permeability), and cytokines (interleukin-6 and interleukin-10) were observed. Treatment resulted in significant changes at 4–6 h. HVHF was beneficial, as shown by the dose of vasoactive drugs, fluid intake volume, left ventricular contractility index, and partial oxygen pressure. Both CRRT and HVHF groups showed improved removal of inflammatory mediators compared with controls. In conclusion, EFR combined with HVHF improved septic shock in this swine model. The combination decreased shock progression, reduced the need for vasoactive drugs, and alleviated the damage to cardiopulmonary functions.

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Very high volume hemofiltration with the Cascade system in septic shock patients

Intensive Care Medicine ◽

10.1007/s00134-015-4056-y ◽

2015 ◽

Vol 41 (12) ◽

pp. 2111-2120 ◽

Cited By ~ 25

Author(s):

Jean-Pierre Quenot ◽

Christine Binquet ◽

Christophe Vinsonneau ◽

Saber-David Barbar ◽

Sandrine Vinault ◽

...

Keyword(s):

Septic Shock ◽

High Volume ◽

Cascade System ◽

High Volume Hemofiltration ◽

Very High

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High-Volume Hemofiltration as Adjuvant Therapy for Refractory Shock after Pericardiocentesis

The Heart Surgery Forum ◽

10.1532/hsf98.20111028 ◽

2011 ◽

Vol 14 (5) ◽

pp. 313

Author(s):

Romuald Lango ◽

Maciej M. Kowalik ◽

Piotr Siondalski ◽

Jan Rogowski ◽

Alicja Dabrowska-Kugacka

Keyword(s):

Cardiac Tamponade ◽

Inflammatory Mediators ◽

Experimental Studies ◽

High Volume ◽

Left Ventricular ◽

Sudden Increase ◽

Refractory Shock ◽

Hemodynamic Deterioration ◽

High Volume Hemofiltration ◽

Hemodynamic Improvement

Background: Pericardiocentesis for the treatment of chronic cardiac tamponade can occasionally result in acute pulmonary edema or biventricular failure. A sudden increase in heart filling pressures and right-to-left ventricular-output mismatch have been proposed underlying mechanisms.Case Report: We report the case of 16-year-old patient who underwent pericardiocentesis for chronic cardiac tamponade 6 weeks after undergoing a Bentall procedure. The patient developed circulatory shock 6 hours after pericardiocentesis. High-volume hemofiltration was used as a rescue therapy after treatment with positive inotropic drugs proved ineffective. An improvement in circulatory function observed after commencement of the hemofiltration treatment was followed by hemodynamic deterioration when the hemofiltration procedure was ceased.Discussion: The mechanism of the observed hemodynamic improvement is unclear. Hemodynamic recovery related in time to high-volume hemofiltration treatment indicates the possible removal of inflammatory mediators. Visceral vasoconstriction resulting from cardiac tamponade and subsequent improvement in gut perfusion after pericardiocentesis that led to washout of inflammatory mediators might have contributed to the development of acute heart failure. Cytokine removal by high-volume hemofiltration and the procedure's relationship to hemodynamic improvement have previously been demonstrated in clinical and experimental studies of septic shock.Conclusions: We conclude that high-volume hemofiltration can be helpful as an adjuvant treatment for refractory shock after pericardiocentesis for chronic cardiac tamponade. The mechanism of the observed hemodynamic improvement remains to be investigated.

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