Abstract | OBJECTIVES: DESIGN: Randomized, controlled intervention trial. SUBJECTS: Forty-eight minipigs of either sex. INTERVENTIONS:
Pancreatitis was induced by intraductal injection of sodium taurocholate (4%, 1 mL/kg body weight [BW]) and enterokinase (2 U/kg BW). Animals were allocated either to untreated controls-group 1-or to one of three treatment groups-group 2: low-volume CVVH (20 mL/kg BW), no change of hemofilters; group 3: low-volume CVVH, filters changed every 12 hrs; and group 4: high-volume CVVH (100 mL/kg BW), filters changed every 12 hrs. Survival represented the major parameter of the study. Serum cytokine levels, sepsis-related down-regulation of major histocompatibility complex II and CD14 expression on leukocytes, bacterial translocation, and endotoxemia were further parameters evaluated in the study. MEASUREMENTS AND MAIN RESULTS: High-volume CVVH combined with periodic filter change was significantly superior compared with less intensive treatment modalities (low-volume CVVH, no filter change) in sepsis protection. Long-term survival (>60 hrs) was found in 67% of group 4 and 33% of group 3 animals (p <.05), whereas in controls and group 2 no animal survived. CVVH ameliorated the initial serum tumor necrosis factor-alpha response and prevented sepsis-induced in vitro endotoxin hyporesponsiveness. Down-regulation of major histocompatibility complex II and CD14 expression on monocytes was significantly improved by CVVH. Improved oxidative burst and phagocytosis capacity in polymorphonuclear leukocytes suggested that leukocyte function was stabilized by CVVH. Also, CVVH significantly reduced bacterial translocation and endotoxemia. CONCLUSIONS:
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Authors | E F Yekebas, C F Eisenberger, H Ohnesorge, A Saalmüller, H A Elsner, M Engelhardt, A Gillesen, J Meins, M The, T Strate, C Busch, W T Knoefel, C Bloechle, J R Izbicki |
Journal | Critical care medicine
(Crit Care Med)
Vol. 29
Issue 7
Pg. 1423-30
(Jul 2001)
ISSN: 0090-3493 [Print] United States |
PMID | 11445702
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Cytokines
- Endotoxins
- Lipopolysaccharide Receptors
- Tumor Necrosis Factor-alpha
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Topics |
- Acute Disease
- Animals
- Bacterial Translocation
- Cytokines
(blood)
- Down-Regulation
- Endotoxins
(blood)
- Genes, MHC Class II
(immunology)
- Hemofiltration
- Immune System Diseases
(etiology, immunology, prevention & control)
- Lipopolysaccharide Receptors
(immunology)
- Monocytes
(immunology)
- Multiple Organ Failure
(etiology, immunology, prevention & control)
- Neutrophils
(immunology)
- Pancreatitis
(immunology, therapy)
- Survival Analysis
- Swine
- Systemic Inflammatory Response Syndrome
(immunology, therapy)
- Tumor Necrosis Factor-alpha
(metabolism)
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