Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Intensive Care
Published in: Annals of Intensive Care 1/2012

Open Access 01-12-2012 | Research

Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients

Authors: Inneke De laet, Dries Deeren, Karen Schoonheydt, Niels Van Regenmortel, Hilde Dits, Manu LNG Malbrain

Published in: Annals of Intensive Care | Special Issue 1/2012

Login to get access

Abstract

Background

Little is known about the effects of renal replacement therapy (RRT) with fluid removal on intra-abdominal pressure (IAP). The global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) can easily be measured bedside by transpulmonary thermodilution (TPTD). The aim of this study is to evaluate the changes in IAP, GEDVI and EVLWI in critically ill patients receiving slow extended daily dialysis (SLEDD) or continuous venovenous haemofiltration (CVVH) with the intention of net fluid removal.

Methods

We performed a retrospective cohort study in ICU patients who were treated with SLEDD or CVVH and in whom IAP was also measured, and RRT sessions were excluded when the dose of vasoactive medication needed to be changed between the pre- and post-dialysis TPTD measurements and when net fluid loss did not exceed 500 ml. The TPTD measurements were performed within 2 h before and after SLEDD; in case of CVVH, before and after an interval of 12 h.

Results

We studied 25 consecutive dialysis sessions in nine patients with acute renal failure and cardiogenic or non-cardiogenic pulmonary oedema. The GEDVI and EVLWI values before dialysis were 877 ml/m² and 14 ml/kg, respectively. Average net ultrafiltration per session was 3.6 l, with a net fluid loss 1.9 l. The GEDVI decreased significantly during dialysis, but not more than 47.8 ml/m² (p = 0.008), as also did the EVLWI with 1 ml/kg (p = 0.03). The IAP decreased significantly from 12 to 10.5 mmHg (p < 0.0001).

Conclusions

Net fluid removal by SLEDD or CVVH in the range observed in this study decreased IAP, GEDVI and EVLWI in critically ill patients although EVLWI reduction was modest.
Literature
1.
Sadler DB, Brown J, Nurse H, Roberts J: Impact of hemodialysis on left and right ventricular Doppler diastolic filling indices. Am J Med Sci 1992,304(2):83–90. 10.1097/00000441-199208000-00003PubMedCrossRef
2.
Chakko S, Girgis I, Contreras G, Perez G, Kessler KM, Myerburg RJ: Effects of hemodialysis on left ventricular diastolic filling. Am J Cardiol 1997,79(1):106–108. 10.1016/S0002-9149(96)00693-5PubMedCrossRef
3.
Kuhn C, Kuhn A, Rykow K, Osten B: Extravascular lung water index: a new method to determine dry weight in chronic hemodialysis patients. Hemodial Int 2006,10(1):68–72. 10.1111/j.1542-4758.2006.01177.xPubMedCrossRef
4.
Compton F, Hoffmann C, Zidek W, Schmidt S, Schaefer JH: Volumetric hemodynamic parameters to guide fluid removal on hemodialysis in the intensive care unit. Hemodial Int 2007,11(2):231–237. 10.1111/j.1542-4758.2007.00174.xPubMedCrossRef
5.
Sakka SG, Hanusch T, Thuemer O, Wegscheider K: The influence of venovenous renal replacement therapy on measurements by the transpulmonary thermodilution technique. Anesth Analg 2007,105(4):1079–1082. table of contents 10.1213/01.ane.0000280440.08530.fbPubMedCrossRef
6.
Malbrain ML, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, Del Turco M, Wilmer A, Brienza N, Malcangi V, Cohen J, Japiassu A, De Keulenaer BL, Daelemans R, Jacquet L, Laterre PF, Frank G, de Souza P, Cesana B, Gattinoni L: Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 2005,33(2):315–322. 10.1097/01.CCM.0000153408.09806.1BPubMedCrossRef
7.
De laet I, Malbrain ML: ICU management of the patient with intra-abdominal hypertension: what to do, when and to whom? Acta Clin Belg Suppl 2007,62(1):190–199.CrossRef
8.
Mullens W, Abrahams Z, Francis GS, Taylor DO, Starling RC, Tang WH: Prompt reduction in intra-abdominal pressure following large-volume mechanical fluid removal improves renal insufficiency in refractory decompensated heart failure. J Card Fail 2008,14(6):508–514. 10.1016/j.cardfail.2008.02.010PubMedCrossRef
9.
Mullens W, Abrahams Z, Skouri HN, Francis GS, Taylor DO, Starling RC, Paganini E, Tang WH: Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function? J Am Coll Cardiol 2008,51(3):300–306. 10.1016/j.jacc.2007.09.043PubMedCrossRef
10.
De laet I, Malbrain ML, Jadoul JL, Rogiers P, Sugrue M: Renal implications of increased intra-abdominal pressure: are the kidneys the canary for abdominal hypertension? Acta Clin Belg Suppl 2007,62(1):119–130.CrossRef
11.
Oda S, Hirasawa H, Shiga H, Matsuda K, Nakamura M, Watanabe E, Moriguchi T: Management of intra-abdominal hypertension in patients with severe acute pancreatitis with continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter. Ther Apher Dial 2005,9(4):355–361. 10.1111/j.1744-9987.2005.00297.xPubMedCrossRef
12.
Kula R, Szturz P, Sklienka P, Neiser J, Jahoda J: A role for negative fluid balance in septic patients with abdominal compartment syndrome? Intensive care medicine 2004,30(11):2138–2139. 10.1007/s00134-004-2423-1PubMedCrossRef
13.
Vachharajani V, Scott LK, Grier L, Conrad S: Medical management of severe intra-abdominal hypertension with aggressive diuresis and continuous ultra-filtration. The Internet Journal of Emergency and Intensive Care Medicine 2003,6(2):41.
14.
Kula R, Szturz P, Sklienka P, Neiser J: Negative fluid balance in patients with abdominal compartment syndrome - case reports. Acta Chir Belg 2008,108(3):346–349.PubMed
15.
Bonfim RF, Goulart AG, Fu C, Torquato JA: Effect of hemodialysis on intra-abdominal pressure. Clinics 2007,62(2):145–150. 10.1590/S1807-59322007000200009PubMedCrossRef
16.
Brivet FG, Jacobs F, Colin P: Calculated global end-diastolic volume does not correspond to the largest heart blood volume: a bias for cardiac function index? Intensive Care Med 2004,30(11):2133–2134. author reply 2135 10.1007/s00134-004-2432-0PubMedCrossRef
17.
Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul JL: Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 2003,124(5):1900–1908. 10.1378/chest.124.5.1900PubMedCrossRef
18.
Combes A: Authors' reply. Intensive Care Med 2004,30(11):2135. 10.1007/s00134-004-2433-zCrossRef
19.
Cheatham ML, Malbrain ML: Cardiovascular implications of abdominal compartment syndrome. Acta Clin Belg Suppl 2007,62(1):98–112.CrossRef
20.
Malbrain ML, De Potter TJ, Dits H, Reuter DA: Global and right ventricular end-diastolic volumes correlate better with preload after correction for ejection fraction. Acta anaesthesiologica Scandinavica 2010,54(5):622–631. 10.1111/j.1399-6576.2009.02202.xPubMedCrossRef
21.
Cox P: Insensible water loss and its assessment in adult patients: a review. Acta Anaesthesiol Scand 1987,31(8):771–776. 10.1111/j.1399-6576.1987.tb02662.xPubMedCrossRef
22.
Michard F: Looking at transpulmonary thermodilution curves: the cross-talk phenomenon. Chest 2004,126(2):656–657.PubMedCrossRef
23.
Pfeiffer UJ, Backus G, Blümel G, Eckart J, Müller P, Winkler P, Zeravik J, Zimermann GJ: A fiberoptics-based system for integrated monitoring of cardiac output, intrathoracic blood volume, extravascular lung water, O2 saturation, and a-v differences. In Practical Applications of Fiberoptics in Critical Care Monitoring. Edited by: Lewis FR, Pfeiffer UJ. Berlin: Springer-Verlag; 1990:114–125.CrossRef
24.
Sakka SG, Ruhl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, Meier-Hellmann A: Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med 2000,26(2):180–187. 10.1007/s001340050043PubMedCrossRef
25.
Malbrain ML: Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive care medicine 2004,30(3):357–371. 10.1007/s00134-003-2107-2PubMedCrossRef
26.
27.
Bland JM, Altman DG: Calculating correlation coefficients with repeated observations: part 2--correlation between subjects. Bmj 1995,310(6980):633. 10.1136/bmj.310.6980.633PubMedCentralPubMedCrossRef
28.
Pavcnik D, Andrews RT, Yin Q, Uchida BT, Timmermans HA, Corless C, Toyota N, Nakata M, Kaufman J, Keller FS, Rösch J: A canine model for studying endoleak after endovascular aneurysm repair. 2003,14(10):1303–1310.
29.
Mitchell JP, Schuller D, Calandrino FS, Schuster DP: Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization. Am Rev Respir Dis 1992,145(5):990–998. 10.1164/ajrccm/145.5.990PubMedCrossRef
30.
Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Wilmer A: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive care medicine 2007,33(6):951–962. 10.1007/s00134-007-0592-4PubMedCrossRef
31.
Poulin S, Brendolan A, Crepaldi C, Gastaldon F, Ronco C: Blood volume monitoring during acute renal replacement therapy. Int J Artif Organs 2003,26(1):3–5.PubMed
32.
Marenzi G, Agostoni P: Hemofiltration in heart failure. Int J Artif Organs 2004,27(12):1070–1076.PubMed
33.
Ronco C, Ricci Z, Brendolan A, Bellomo R, Bedogni F: Ultrafiltration in patients with hypervolemia and congestive heart failure. Blood Purif 2004,22(1):150–163. 10.1159/000074936PubMedCrossRef
34.
Metry G, Wegenius G, Hedenstrom H, Wikstrom B, Danielson BG: Computed tomographic measurement of lung density changes in lung water with hemodialysis. Nephron 1997,75(4):394–401. 10.1159/000189576PubMedCrossRef
35.
Susini G, Zucchetti M, Bortone F, Salvi L, Cipolla CM, Rimondini A, Sisillo E: Isolated ultrafiltration in cardiogenic pulmonary edema. Crit Care Med 1990,18(1):14–17. 10.1097/00003246-199001000-00004PubMedCrossRef
36.
Laggner AN, Druml W, Lenz K, Schneeweiss B, Grimm G: Influence of ultrafiltration/hemofiltration on extravascular lung water. Contrib Nephrol 1991, 93: 65–70.PubMedCrossRef
37.
Sivak ED, Tita J, Meden G, Ishigami M, Graves J, Kavlich J, Stowe NT, Magnusson MO: Effects of furosemide versus isolated ultrafiltration on extravascular lung water in oleic-acid induced pulmonary edema. Crit Care Med 1986,14(1):48–51. 10.1097/00003246-198601000-00011PubMedCrossRef
38.
Su X, Bai C, Hong Q, Zhu D, He L, Wu J, Ding F, Fang X, Matthay MA: Effect of continuous hemofiltration on hemodynamics, lung inflammation and pulmonary edema in a canine model of acute lung injury. Intensive Care Med 2003,29(11):2034–2042. 10.1007/s00134-003-2017-3PubMedCrossRef
39.
Mason N, Froude A, Holst B, Saayman A, Findlay G: The effect of continuous veno-venous haemofiltration on PiCCO haemodynamic parameters (abstract P65). Crit Care 2005,9(Suppl 1):S26. 10.1186/cc3089CrossRef
Metadata
Title
Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients
Authors
Inneke De laet
Dries Deeren
Karen Schoonheydt
Niels Van Regenmortel
Hilde Dits
Manu LNG Malbrain
Publication date
01-12-2012
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue Special Issue 1/2012
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/2110-5820-2-S1-S20

Other articles of this Special Issue 1/2012

Annals of Intensive Care 1/2012 Go to the issue

Research

Intra-abdominal pressure, intra-abdominal hypertension, and pregnancy: a review

Research

Effect of mechanical ventilation on intra-abdominal pressure in critically ill patients without other risk factors for abdominal hypertension: an observational multicenter epidemiological study

Research

Early continuous veno-venous haemofiltration in the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years' experience

Research

Recognition and management of abdominal compartment syndrome among German pediatric intensivists: results of a national survey

Research

Incidence and prognosis of intra-abdominal hypertension in critically ill medical patients: a prospective epidemiological study

Research

Recognition and management of abdominal compartment syndrome among German anesthetists and surgeons: a national survey