Abstract | OBJECTIVES: DESIGN: PATIENTS: 33 ventilated patients with acute renal failure of septic (n = 18) and cardiovascular origin (n = 15) were studied. INTERVENTIONS: Hemodynamic monitoring and collection of blood and ultrafiltrate samples before and during the first 72 h of continuous hemofiltration. MEASUREMENTS AND MAIN RESULTS: Cardiovascular hemodynamics (Swan-Ganz catheter), Acute Physiology and Chronic Health Evaluation II score, creatinine, electrolytes, and blood urea nitrogen were recorded daily. Cytokines ( TNF alpha, TNF alpha-RII, interleukin (IL) 1beta, IL1RA, IL2, IL2R, IL6, IL6R, IL8, IL10) were measured in prefilter blood and in ultrafiltrate immediately preceding and 12, 24, 48, and 72 h after initiating continuous venovenous hemofiltration (CVVH). Septic patients showed elevated cardiovascular values for cardiac output (7.2 +/- 2.1 l/min), cardiac index (4.2 +/- 1.3 l/min per m2), and stroke volume (67 +/- 23 ml) and reduced values for systemic vascular resistance (540 +/- 299 dyn x s x cm(-5)). All hemodynamic values normalized within the first 24 h after initiating CVVH treatment. TNF alpha was 1833 +/- 1217 pg/ml in septic patients and 42.9 +/- 6.3 pg/ml in nonseptic patients (p < 0.05) prior to CVVH. TNF alpha was detected in ultrafiltrate but did not decrease in blood during treatment with CVVH. There was no difference in IL 1beta between septic (3.8 +/- 1.9 pg/ml) and nonseptic patients (1.7 +/- 0.5 pg/ml). No significant elimination of cytokines was achieved in the present study by CVVH treatment. CONCLUSIONS:
|
Authors | P Heering, S Morgera, F J Schmitz, G Schmitz, R Willers, H P Schultheiss, B E Strauer, B Grabensee |
Journal | Intensive care medicine
(Intensive Care Med)
Vol. 23
Issue 3
Pg. 288-96
(Mar 1997)
ISSN: 0342-4642 [Print] United States |
PMID | 9083231
(Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article)
|
Chemical References |
- Cytokines
- Tumor Necrosis Factor-alpha
|
Topics |
- APACHE
- Adult
- Aged
- Analysis of Variance
- Critical Illness
- Cytokines
(blood)
- Female
- Hemodynamics
- Hemofiltration
- Humans
- Male
- Middle Aged
- Prospective Studies
- Renal Insufficiency
(blood, etiology, therapy)
- Sepsis
(blood, complications, therapy)
- Statistics, Nonparametric
- Tumor Necrosis Factor-alpha
(analysis)
|