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01-05-2006 | Original

High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock

Authors: Rodrigo Cornejo, Patricio Downey, Ricardo Castro, Carlos Romero, Tomas Regueira, Jorge Vega, Luis Castillo, Max Andresen, Alberto Dougnac, Guillermo Bugedo, Glenn Hernandez

Published in: Intensive Care Medicine | Issue 5/2006

Abstract

Objectives

To evaluate the effect of short-term (12-h) high-volume hemofiltration (HVHF) in reversing progressive refractory hypotension and hypoperfusion in patients with severe hyperdynamic septic shock. To evaluate feasibility and tolerance and to compare observed vs. expected hospital mortality.

Design and setting

Prospective, interventional, nonrandomized study in the surgical-medical intensive care unit of an academic tertiary center.

Patients

Twenty patients with severe septic shock, previously unresponsive to a multi-intervention approach within a goal-directed, norepinephrine-based algorithm, with increasing norepinephrine (NE) requirements (> 0.3 μg kg^–1 min^–1) and lactic acidosis.

Interventions

Single session of 12-h HVHF.

Measurements and results

We measured changes in NE requirements and perfusion parameters every 4 h during HVHF and 6 h thereafter. Eleven patients showed decreased NE requirements and lactate levels (responders). Nine patients did not fulfill these criteria (nonresponders). The NE dose, lactate levels, and heart rates decreased and arterial pH increased significantly in responders. Hospital mortality (40%) was significantly lower than predicted (60%): 67% (6/9) in nonresponders vs. 18% (2/11) in responders. Of 12 survivors 7 required only a single 12-h HVHF session. On logistic regression analysis the only statistically significant predictor of survival was theresponse to HVHF (odds ratio 9).

Conclusions

A single session of HVHF as salvage therapy in the setting of a goal-directed hemodynamic management algorithm may be beneficial in severe refractory hyperdynamic septic-shock patients. This approach may improve hemodynamics and perfusion parameters, acid-base status, and ultimately hospital survival. Moreover, it is feasible, and safe.

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Title: High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock
Authors: Rodrigo Cornejo
Patricio Downey
Ricardo Castro
Carlos Romero
Tomas Regueira
Jorge Vega
Luis Castillo
Max Andresen
Alberto Dougnac
Guillermo Bugedo
Glenn Hernandez
Publication date: 01-05-2006
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-006-0118-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock

Abstract

Objectives

Design and setting

Patients

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Design and setting

Patients

Interventions

Measurements and results

Conclusions

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