Continuous Venovenous Hemodiafiltration (CVVHDF): Effects on Global Hemodynamics and Gastric Mucosal Energy Balance

Overview

Objective:
To assess the impact of continuous venovenous hemodiafiltration (CVVHDF) initiation on central hemodynamics, oxygen transport andgastric mucosal energy metabolismDesign: Prospective clinical study.Setting: University Hospital medical intensive care unit.Subjects: Fourteen critically ill patients with acute renal failure.Methods: Gastric mucosal PCO2 (pgmCO2) was measured using gastric tonometry at baseline and then at 1,2,3 and 6 hours after starting CVVHDFand gastric mucosal to arterialPCO2 gradient (PCO2gap) was calculated. Whole body hemodynamics was measured invasively (arterial and pulmonaryarterial catheters).Results: PCO2gap remained stable during the first 6 hrs of CVVHDF treatment. Mean arterial pressure, cardiac output, systemic vascular resistanceand global oxygen consumption remained also unaltered although systemic vascular resistance increased.Conclusions: CVVHDF initiation in hemodynamically stable critically ill patients has minor effects on the whole body hemodynamics withoutinfluencing gastric mucosal energy balance.

Key words:
CRRT – acute renal failure – gastric tonometry – monitoring – critically ill