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The consequences of continuous haemofiltration on lung mechanics and extravascular lung water in a porcine endotoxic shock model

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Abstract

Endotoxinaemia (E. coli endotoxin, 0.111.B4) and pulmonary hypertension were evoked in 20 swine, randomly assigned to receive either zero-balanced venovenous haemofiltration (HF) with an ultrafiltration and replacement rate of 600 ml/h (HF group,n=10) or to undergo an uninfluenced spontaneous course (E group,n=10) during a constant infusion of endotoxin until the end of the experiment. Endotoxin-induced pulmonary dysfunction was assessed on the basis of extravascular lung water (EVLW) using a thermo-dye technique via a fiberoptic intra-aortic probe, gas exchange and lung mechanics, the latter derived by a pressure-volume loop (P/V loop) of the respiratory system (super syringe, flow 30 ml/s, tidal volume 600 ml). A comparable increase in alveolo-arterial oxygen difference and a constant EVLW was observed in both groups. The progessive deterioration of hysteresis area and compliance parameters by endotoxinaemia was significantly blunted by HF. Independent of an impact on pulmonary oedema zero-balanced HF modifies endotoxin induced lung injury, probably by the convectice transport of mediator substances.

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References

  1. Mauritz W, Sporn P, Schindler I, Zadrobilek E, Roth E, Appel W (1986) Akutes Nierenversagen bei abdomineller Sepsis—Vergleich von Hämodialyse and kontinuierlicher ateriovenöser Hämofiltration. Anaesth Intensivther Notfallmed 21:212–217

    Google Scholar 

  2. Simpson K, Allison M (1988) Acute renal failure — continuous ultrafiltration and bicarbonate haemodialysis (CUPID). Intensive Care World 5:83–84

    Google Scholar 

  3. Wardle N (1982) Acute renal failure in the 1980's: the importance of septic shock and of endotoxinaemia. Nephron 30:193–200

    Google Scholar 

  4. Cameron JS (1986) Acute renal failure in the intensive care unit today. Intensive Care Med 12:64–70

    Google Scholar 

  5. Schetz M, Lauwers PM, Ferdinande P (1989) Extracorporeal treatment of acute renal failure in the intensive care unit: a critical view. Intensive Care Med 15:349–357

    Google Scholar 

  6. Wendon J, Smithies M, Sheppard M, Bullen K, Tinker J, Bihari D (1989) Continuous high volume veno-venous haemofiltration in acute renal failure. Intensive Care Med 15:358–363

    Google Scholar 

  7. Gotloib L, Barzilay E, Shustak A, Wais Z, Jaichenko J, Lev A (1986) Hemofiltration in septic ARDS. The artifical kidney as an artificial endocrine lung. Resuscitation 13:123–132

    Google Scholar 

  8. Gotloib L, Barzilay E, Shustak A, Wais Z, Lev A (1985) Hemofiltration in severe septic adult respiratory distress syndrome associated with Varicella. Intensive Care Med 11:319–322

    Google Scholar 

  9. Stein B, Pfenninger E, Grünert A, Schmitz JE, Hudde M (1990) Influence of continuous haemofiltration on haemodynamics and central blood volume in experimental endotoxic shock. Intensive Care Med 16:494–499

    Google Scholar 

  10. Staubach KH, Rau HG, Kooistra A, Schardey HM, Hohlbach G, Schildberg FW (1988) Can hemofiltration increase survival time in acute endotoxinemia — a porcine shock model. Abstract: Second Vienna Shock Forum, Mey 11–14, 1988, Vienna, Austria, p 69

  11. Gomez A, Wang R, Unruh H, Light RB, Bose D, Chau T, Correa E, Mink S (1990) Hemofiltration reveries left ventricular dysfunction during sepsis in dogs. Anesthesiology 73:671–685

    Google Scholar 

  12. Kühl PG, Bolds JM, Loyd J, Snapper JR, Fitzgerald GA (1988) Thromboxane receptor-mediated bronchial and hemodynamic responses in ovine endotoxinemia. Am J Physiol 254:R 310–319

    Google Scholar 

  13. Brigham KL, Meyrick B (1986) Endotorin and lung injury. Am Rev Respir Dis 133:913–927

    Google Scholar 

  14. Ball HA, Cook JA, Wise WC, Halushka PV (1986) Role of thromboxane, prostaglandins and leukotrienes in endotoxic and septic shock. Intensive Care Med 12:116–126

    Google Scholar 

  15. Snapper JR, Coggeshall JW, Serafin WE, Phillips MA, Lefferts PL, Christman BW (1987) Role of leukotrienes in an animal model of the adult respiratory distress syndrome. In: Samuelsson B, Paoletti R, Ramwell PW (eds) Advances in prostaglandin, thromboxane, and leukotriene research. Raven Press, New York, pp 1043–1046

    Google Scholar 

  16. Gross D, Dahan JB, Landau EH, Krausz MM (1990) Effect of leukotriene inhibitor LY-171883 on the pulmonary response to Escherichia coli endotoxinemia. Crit Care Med 18:190–197

    Google Scholar 

  17. Wickerts CJ, Jakobsson J, Frostell C, Hedenstierna G (1990) Measurement of extravascular lung water by thermal-dye dilution technique: mechanisms of cardiac output dependence. Intensive Care Med 16:115–120

    Google Scholar 

  18. Stein B, Maucher H, Wiedeck H, Born B, Ahnefeld FW (1989) Die Steuerung der Ultrafiltrationsrate als Hauptkomponente eines neuen Bilanzierungssystemes während kontinulerlicher Hämofiltration. Anaesthesist 38:536–538

    Google Scholar 

  19. Mankikian B, Lemaire F, Benito S, Brun-Buisson C, Harf A, Maillot JP, Becker J (1983) A new device for measurement of pulmonary pressure volume curves in patients on mechanical ventilation. Crit Care Med 11:897–901

    Google Scholar 

  20. Gattinoni L, Mascheroni D, Basilico E, Foti G, Pesenti A, Avalli L (1987) Volume/pressure curve of total respiratory system in paralysed patients: artefacts and correction factors. Intensive Care Med 13:19–25

    Google Scholar 

  21. Dall'Ava-Santucci J, Armaganidis A, Brunet F, Dhainaut JF, Chelucci GL, Monsallier JF, Lockhardt A (1988) Causes of error of respiratory pressure-volume curves in paralyzed subjects. J Appl Physiol 64:42–49

    Google Scholar 

  22. Beutler B, Cerami A (1987) Cachectin: More than a tumor necrosis factor. N Engl J Med 316:379–385

    Google Scholar 

  23. Oettinger W, Beger HG (1989) How spacific is eicosanoid release in the surgical sepsis syndrome. Theor Surg 3:171–180

    Google Scholar 

  24. Sweet SJ, Glenney CU, Fitzgibbons JP, Friedmann P, Teres D (1981) Synergistic effect of acute renal failure and respiratory failure in the surgical intensive care unit. Am J Surg 141:492–495

    Google Scholar 

  25. Kramer P, Wigger W, Rieger J et al: Arterious hemofiltration: a new simple method for treatment of overhydrated patients resistant to diuretics. Klin Wochenschr 1977; 55:1121

    Google Scholar 

  26. Wilkowski A, Goeckenjan G (1988) Auswirkungen des Flüssigkeitsentzuges auf pulmonale Verlaufsparameter und Prognose des akuten Lungenversagens. Intensivmedizin 25:10–16

    Google Scholar 

  27. Deby-Dupont G, Braun M, Lamy M, Deby C, Pincemail J, Faymonville ME, Damas P, Bodson L, Lecart MP, Goutier R (1987) Thromboxane and prostacyclin release in adult respiratory distress syndrome. Intensive Care Med 13:167–174

    Google Scholar 

  28. Antonelli M, Bufi M, De Blasi RA, Crimi G, Conti G, Mattia C, Vivino G, Lenti L, Lombardi D, Dotta A, Pontieri G, Gasparetto (1989) Detection of leukotrienes B4, C4 and of their isomers in arterial, mixed venous blood and bronchoalveolar lavage fluid from ARDS patients. Intensive Care Med 15:296–301

    Google Scholar 

  29. Lava JS, Rice CL, Levine HA, Moss GS (1982) Extravascular lung water as a function of the magnitude of pulmonary artery pressure in the septic pig. J Surg Res 32:440–447

    Google Scholar 

  30. Olson NC, Brown TT, Anderson DL (1985) Dexamethasone and indomethacin modify endotoxin-induced respiratory failure in pigs. J Appl Physiol 58:274–284

    Google Scholar 

  31. Magilligan DJ (1985) Effects of Ultrafiltration on Lung Water. In: Sieberth HG, Mann H (eds) Continuous arteriovenous hemofiltration (CAVH). Rarger, Basel, pp 80–95

    Google Scholar 

  32. Coraim FJ, Coraim HP, Ebermann R, Stellwag FM (1986) Acute respiratory failure after cardiac surgery: clinical experience with the application of continuous hemofiltration. Crit Care Med 14:714–718

    Google Scholar 

  33. McCaffree DR, Gray BA, Pennock BE, Coalson J, Bridges C, Taylor FB, Rogers RM (1981) Role of pulmonary edema in the acute pulmonary response to sepsis. J Appl Physiol 50:1198–1205

    Google Scholar 

  34. Esbenshade AM, Newman JH, Lams PM, Jolles H, Brigham KL (1982) Respiratory failure after endotoxin infusion in sheep: lung mechanics and lung fluid balance. J Appl Physiol 53:967–976

    Google Scholar 

  35. Nielson D, Olsen DB (1978) The Role of alveolar recruitment and de-recruitment in pressure-volume hysteresis in lungs. Respir Physiol 32:63–77

    Google Scholar 

  36. Andreasson S, Bylock A, Smith L, Risberg B (1986) Extravascular lung water measurement in septic sheep. J Surg Res 40:95–104

    Google Scholar 

  37. Golper TA, Jenkins R, Wright M, Klein JB (1990) Tumor necrosis factor (TNF) and hemofiltration membranes. (Abstract) Intensivbehandlung 15:119

    Google Scholar 

  38. Sznajder JI, Zucker AR, Wood LDH, Long GR (1986) The effects of plasmapheresis and hemofiltration on canine acid aspiration pulmonary edema. Am Rev Respir Dis 134:222–228

    Google Scholar 

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  1. B. Stein

    Present address: CHRU Nancy, Département d'Anesthésiologie, Hôpital Central, B. P. No. 34, F-54037, Nancy Cedex, France

Authors and Affiliations

  1. Universitätsklinik für Anaesthesiologie, Klinikum der Universität Ulm, Steinhövelstr. 9, W-7900, Ulm/Donau, FRG

    B. Stein, E. Pfenninger, A. Grünert, J. E. Schmitz, A. Deller & F. Kocher

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  1. B. Stein
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  2. E. Pfenninger
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  4. J. E. Schmitz
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  5. A. Deller
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Stein, B., Pfenninger, E., Grünert, A. et al. The consequences of continuous haemofiltration on lung mechanics and extravascular lung water in a porcine endotoxic shock model. Intensive Care Med 17, 293–298 (1991). https://doi.org/10.1007/BF01713941

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  • DOI: https://doi.org/10.1007/BF01713941

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