Top

Published in:

Open Access 01-02-2009 | Experimental

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

Authors: Roman Sykora, Jiri Chvojka, Ales Krouzecky, Jaroslav Radej, Thomas Karvunidis, Veronika Varnerova, Ivan Novak, Martin Matejovic

Published in: Intensive Care Medicine | Issue 2/2009

Abstract

Objective

The role of haemofiltration as an adjunctive treatment of sepsis remains a contentious issue. To address the role of dose and to explore the biological effects of haemofiltration we compared the effects of standard and high-volume haemofiltration (HVHF) in a peritonitis-induced model of porcine septic shock.

Design and setting

Randomized, controlled experimental study.

Subjects

Twenty-one anesthetized and mechanically ventilated pigs.

Interventions

After 12 h of hyperdynamic peritonitis, animals were randomized to receive either supportive treatment (Control, n = 7) or standard haemofiltration (HF 35 ml/kg per h, n = 7) or HVHF (100 ml/kg per hour, n = 7).

Measurements and results

Systemic and hepatosplanchnic haemodynamics, oxygen exchange, energy metabolism (lactate/pyruvate, ketone body ratios), ileal and renal cortex microcirculation and systemic inflammation (TNF-α, IL-6), nitrosative/oxidative stress (TBARS, nitrates, GSH/GSSG) and endothelial/coagulation dysfunction (von Willebrand factor, asymmetric dimethylarginine, platelet count) were assessed before, 12, 18, and 22 h of peritonitis. Although fewer haemofiltration-treated animals required noradrenaline support (86, 43 and 29% animals in the control, HF and HVHF groups, respectively), neither of haemofiltration doses reversed hyperdynamic circulation, lung dysfunction and ameliorated alterations in gut and kidney microvascular perfusion. Both HF and HVHF failed to attenuate sepsis-induced alterations in surrogate markers of cellular energetics, nitrosative/oxidative stress, endothelial injury or systemic inflammation.

Conclusions

In this porcine model of septic shock early HVHF proved superior in preventing the development of septic hypotension. However, neither of haemofiltration doses was capable of reversing the progressive disturbances in microvascular, metabolic, endothelial and lung function, at least within the timeframe of the study and severity of the model.

Available only for authorised users

Cariou A, Vinsonneau C, Dhainaut JF (2004) Adjunctive therapies in sepsis: an evidence-based review. Crit Care Med 32:S562–S570PubMedCrossRef

Honoré PM, Joannes-Boyau O, Gressens B (2007) Blood and plasma treatments: the rationale of high-volume haemofiltration. Contrib Nephrol 156:387–395PubMedCrossRef

Bellomo R, Honoré PM, Matson J, Ronco C, Winchester J (2005) Extracorporeal blood treatment (EBT) methods in SIRS/Sepsis. Int J Artif Organs 28:450–458PubMed

Cole L, Bellomo R, Hart G, Journois D, Davenport P, Tipping P, Ronco C (2002) A phase II randomized, controlled trial of continuous haemofiltration in sepsis. Crit Care Med 30:100–106PubMedCrossRef

Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, La Greca G (2000) Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 356:26–30PubMedCrossRef

Saudan P, Niederberger M, De Seigneux S, Romand J, Pugin J, Perneger T, Martin PY (2006) Adding a dialysis dose to continuous haemofiltration increases survival in patients with acute renal failure. Kidney Int 70:1312–1317PubMedCrossRef

Schiffl H, Lang SM, Fischer R (2002) Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 31:305–310CrossRef

Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, Finkel K, Kellum JA, Paganini E, Schein RM, Smith MW, Swanson KM, Thompson BT, Vijayan A, Watnick S, Star RA, Peduzzi P (2008) The VA/NIH acute renal failure trial network intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 359:7–20PubMedCrossRef

Cole L, Bellomo R, Journois D, Davenport P, Baldwin I, Tipping P (2001) High-volume haemofiltration in human septic shock. Intensive Care Med 27:978–986PubMedCrossRef

10.

Honore PM, Jamez J, Wauthier M, Lee PA, Dugernier T, Pirenne B, Hanique G, Matson JR (2000) Prospective evaluation of short-term, high-volume isovolemic haemofiltration on the hemodynamic course and outcome in patients with intractable circulatory failure resulting from septic shock. Crit Care Med 28:3581–3587PubMedCrossRef

11.

Ratanarat R, Brendolan A, Piccinni P, Dan M, Salvatori G, Ricci Z, Ronco C (2005) Pulse high-volume haemofiltration for treatment of severe sepsis: effects on haemodynamics and survival. Crit Care 9:294–302CrossRef

12.

Oudemans-van Straaten HM, Bosman RJ, van der Spoel JI, Zandstra DF (1999) Outcome of critically ill patients treated with intermittent high-volume haemofiltration: a prospective cohort analysis. Intensive Care Med 25:814–821PubMedCrossRef

13.

Joannes-Boyau O, Rapaport S, Bazin R, Fleureau C, Janvier G (2004) Impact of high volume haemofiltration on hemodynamic disturbance and outcome during septic shock. ASAIO J 50:102–109PubMedCrossRef

14.

Piccinni P, Dan M, Barbacini S, Carraro R, Lieta E, Marafon S, Zamperetti N, Brendolan A, D’Intini V, Tetta C, Bellomo R, Ronco C (2006) Early isovolaemic haemofiltration in oliguric patients with septic shock. Intensive Care Med 32:80–86PubMedCrossRef

15.

Cornejo R, Downey P, Castro R, Romero C, Regueira T, Vega J, Castillo L, Andresen M, Dougnac A, Bugedo G, Hernandez G (2006) High-volume haemofiltration as salvage therapy in severe hyperdynamic septic shock. Intensive Care Med 32:713–722PubMedCrossRef

16.

Grootendorst AF, van Bommel EF, van der Hoven B, van Leengoed LA, van Osta AL (1992) High volume haemofiltration improves right ventricular function in endotoxin-induced shock in the pig. Intensive Care Med 18:235–240PubMedCrossRef

17.

Ullrich R, Roeder G, Lorber C, Quezado ZM, Kneifel W, Gasser H, Schlag G, Redl H, Germann P (2001) Continuous venovenous haemofiltration improves arterial oxygenation in endotoxin-induced lung injury in pigs. Anesthesiology 95:428–436PubMedCrossRef

18.

Yekebas EF, Eisenberger CF, Ohnesorge H, Saalmüller A, Elsner HA, Engelhardt M, Gillesen A, Meins J, The M, Strate T, Busch C, Knoefel WT, Bloechle C, Izbicki JR (2001) Attenuation of sepsis-related immunoparalysis by continuous veno-venous haemofiltration in experimental porcine pancreatitis. Crit Care Med 29:1423–1430PubMedCrossRef

19.

Bellomo R, Kellum JA, Gandhi CR, Pinsky MR, Ondulik B (2000) The effect of intensive plasma water exchange by haemofiltration on haemodynamics and soluble mediators in canine endotoxemia. Am J Respir Crit Care Med 161:1429–1436PubMed

20.

Rogiers P, Zhang H, Smail N, Pauwels D, Vincent JL (1999) Continuous venovenous haemofiltration improves cardiac performance by mechanisms other than tumor necrosis factor-alpha attenuation during endotoxic shock. Crit Care Med 27:1848–1855PubMedCrossRef

21.

Bouman CS, Oudemans-van Straaten HM, Schultz MJ, Vroom MB (2007) Haemofiltration in sepsis and systemic inflammatory response syndrome: the role of dosing and timing. J Crit Care 22:1–12PubMedCrossRef

22.

Matejovic M, Krouzecky A, Martinkova V, Rokyta R Jr, Kralova H, Treska V, Radermacher P, Novak I (2004) Selective inducible nitric oxide synthase inhibition during long-term hyperdynamic porcine bacteremia. Shock 21:458–465PubMedCrossRef

23.

Matejovic M, Krouzecky A, Martinkova V, Rokyta R Jr, Radej J, Kralova H, Treska V, Radermacher P, Novak I (2005) Effects of tempol, a free radical scavenger, on long-term hyperdynamic porcine bacteremia. Crit Care Med 33:1057–1063PubMedCrossRef

24.

Matejovic M, Krouzecky A, Rokyta R Jr, Radej J, Kralova H, Treska V, Radermacher P, Novak I (2007) Effects of combining inducible nitric oxide synthase inhibitor and radical scavenger during porcine bacteremia. Shock 27:61–68PubMedCrossRef

25.

Tugtekin IF, Radermacher P, Theisen M, Matejovic M, Stehr A, Ploner F, Matura K, Ince C, Georgieff M, Träger K (2001) Increased ileal–mucosal–arterial PCO₂ gap is associated with impaired villus microcirculation in endotoxic pigs. Intensive Care Med 27:757–766PubMedCrossRef

26.

De Backer D, Hollenberg S, Boerma C, Goedhart P, Büchele G, Ospina-Tascon G, Dobbe I, Ince C (2007) How to evaluate the microcirculation: report of a round table conference. Crit Care 10;11:R101

27.

Yekebas EF, Strate T, Zolmajd S, Eisenberger CF, Erbersdobler A, Saalmüller A, Steffani K, Busch C, Elsner HA, Engelhardt M, Gillesen A, Meins J, The M, Knoefel WT, Izbicki JR (2002) Impact of different modalities of continuous venovenous haemofiltration on sepsis-induced alterations in experimental pancreatitis. Kidney Int 62:1806–1818PubMedCrossRef

28.

Asfar P, Hauser B, Radermacher P, Matejovic M (2006) Catecholamines and vasopressin during critical illness. Crit Care Clin 22:131–149PubMedCrossRef

29.

Landry DW, Oliver JA (2001) The pathogenesis of vasodilatory shock. N Engl J Med 345:588–595PubMedCrossRef

30.

Takakura K, Taniguchi T, Muramatsu I, Takeuchi K, Fukuda S (2002) Modification of alfa-1 adrenoreceptors by peroxynitrite as a possible mechanism of systemic hypotension in sepsis. Crit Care Med 30:894–899PubMedCrossRef

31.

Takakura K, Xiaohong W, Takeuchi K, Yasuda Y, Fukuda S (2003) Deactivation of noradrenaline by peroxynitrite as a new pathogenesis in the hypotension of septic shock. Anestesiology 98:928–934CrossRef

32.

Macarthur H, Couri DM, Wilken GH, Westfall TC, Lechner AJ, Matuschak GM, Chen Z, Salvemini D (2003) Modulation of serum cytokine levels by a novel superoxide dismutase mimetic, M40401, in an Escherichia coli model of septic shock: correlation with preserved circulating catecholamines. Crit Care Med 31:237–245PubMedCrossRef

33.

Rokyta R Jr, Matejovic M, Krouzecky A, Opatrny K Jr, Ruzicka J, Novak I (2004) Effects of continuous venovenous haemofiltration-induced cooling on global haemodynamics, splanchnic oxygen and energy balance in critically ill patients. Nephrol Dial Transplant 19:623–630PubMedCrossRef

34.

Marsh JD, Margolis TI, Kim D (1988) Mechanism of diminished contractile response to catecholamines during acidosis. Am J Physiol 254:H20–H27PubMed

35.

Kellum JA, Song M, Venkataraman R (2004) Effects of hyperchloremic acidosis on arterial pressure and circulating inflammatory molecules in experimental sepsis. Chest 125:243–248PubMedCrossRef

36.

Rogiers P, Sun Q, Dimopoulos G, Tu Z, Pauwels D, Manhaeghe C, Su F, Vincent JL (2006) Blood warming during haemofiltration can improve haemodynamics and outcome in ovine septic shock. Anesthesiology 104:1216–1222PubMedCrossRef

37.

Ronco C, Tetta C, Mariano F, Wratten ML, Bonello M, Bordoni V, Cardona X, Inguaggiato P, Pilotto L, d’Intini V, Bellomo R (2003) Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis. Artif Organs 27:792–801PubMedCrossRef

38.

Hoffmann JN, Hartl WH, Deppisch R, Faist E, Jochum M, Inthorn D (1996) Effect of haemofiltration on haemodynamics and systemic concentrations of anaphylatoxins and cytokines in human sepsis. Intensive Care Med 22:1360–1367PubMedCrossRef

39.

Silvester W (1997) Mediator removal with CRRT: complement and cytokines. Am J Kidney Dis 30:S38–S43PubMedCrossRef

40.

Wang Y, Liu Y, Sarker KP, Nakashima M, Serizawa T, Kishida A, Akashi M, Nakata M, Kitajima I, Maruyama I (2000) Polymyxin B binds to anandamide and inhibits its cytotoxic effect. FEBS Lett 24(470):151–155

41.

Trzeciak S, Dellinger RP, Parrillo JE, Guglielmi M, Bajaj J, Abate NL, Arnold RC, Colilla S, Zanotti S, Hollenberg SM (2007) Microcirculatory alterations in resuscitation and shock investigators early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to haemodynamics, oxygen transport, and survival. Ann Emerg Med 49:88–98PubMedCrossRef

42.

Leverve XM (1999) From tissue perfusion to metabolic marker: assessing organ competition and co-operation in critically ill patients? Intensive Care Med 25:890–892PubMedCrossRef

43.

Li CM, Chen JH, Zhang P, He Q, Yuan J, Chen RJ, Cheng XJ, Tan HZ, Yang Y (2007) Continuous veno-venous haemofiltration attenuates myocardial mitochondrial respiratory chain complexes activity in porcine septic shock. Anaesth Intensive Care 35:911–919PubMed

44.

Joannes-Boyau O, Honore PM, Boer W (2006) Haemofiltration: the case for removal of sepsis mediators from where they do harm. Crit Care Med 34:2244–2246PubMedCrossRef

45.

Honoré PM, Matson JR (2004) Extracorporeal removal for sepsis: acting at the tissue level—the beginning of a new era for this treatment modality in septic shock. Crit Care Med 32:896–897PubMedCrossRef

46.

Ronco C (2007) The immunomodulatory effect of extracorporeal therapies in sepsis: a reconciliation of three theories. Int J Artif Organs 30:855–857PubMed

47.

Hack CE, Zeerleder S (2001) The endothelium in sepsis: source of and target for inflammation. Crit Care Med 29:S21–S27PubMedCrossRef

48.

Schouten M, Wiersinga WJ, Levi M, van der Poll T (2008) Inflammation, endothelium, and coagulation in sepsis. J Leukoc Biol 83:536–545PubMedCrossRef

49.

Reinhart K, Bayer O, Brunkhorst F, Meisner M (2002) Markers of endothelial damage in organ dysfunction and sepsis. Crit Care Med 30:S302–S312PubMedCrossRef

50.

Polanska K, Opatrny K Jr, Rokyta R Jr, Krouzecky A, Vit L, Kasal E (2006) Effect of regional citrate anticoagulation on thrombogenicity and biocompatibility during CVVHDF. Ren Fail 28:107–118PubMedCrossRef

51.

Honore’ PM, Joannes-Boyau O, Merson L, Boer W, Piette V, Galloy AC, Janvier G (2006) The big bang of haemofiltration: the beginning of a new era in the third millennium for extra-corporeal blood purification! Int J Artif Organs 29:649–659PubMed

52.

Mink SN, Li X, Bose D, Gu M, Liu G, Jacobs H, Light RB (1999) Early but not delayed continuous arteriovenous haemofiltration improves cardiovascular function in sepsis in dogs. Intensive Care Med 25:733–743PubMedCrossRef

Title: High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?
Authors: Roman Sykora
Jiri Chvojka
Ales Krouzecky
Jaroslav Radej
Thomas Karvunidis
Veronika Varnerova
Ivan Novak
Martin Matejovic
Publication date: 01-02-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 2/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1318-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

Abstract

Objective

Design and setting

Subjects

Interventions

Measurements and results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Design and setting

Subjects

Interventions

Measurements and results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2009

The PROWESS SHOCK trial: reply to Paramesh et al.

Reply to Wiedermann

Physiotherapy does not prevent, or hasten recovery from, ventilator-associated pneumonia in patients with acquired brain injury

The strong ion gap and outcome after cardiac arrest in patients treated with therapeutic hypothermia: a retrospective study

Respiratory, metabolic and hemodynamic effects of clonidine in ventilated patients presenting with withdrawal syndrome

Mortality in acute cardiogenic pulmonary edema treated with continuous positive airway pressure