High- versus standard-volume haemofiltration in experimental peritonitis-induced sepsis
Authors:
Sýkora Roman 1,2; Chvojka Jiří 1,2; Kroužecký Aleš 1,2; Raděj Jaroslav 1,2; Karvunidis Thomas 1,2; Varnerová Veronika 2; Novák Ivan 1,2; Matějovič Martin 1,2
Authors‘ workplace:
Jednotka intenzivní péče, I. interní klinka, Fakultní nemocnice Plzeň
1; Lékařská fakulta v Plzni, Univerzita Karlova v Praze
2
Published in:
Anest. intenziv. Med., 20, 2009, č. 5, s. 246-256
Category:
Intensive Care Medicine - Original Paper
Overview
Objective:
The role of haemofiltration as an adjunctive treatment of sepsis remains a contentious issue. To address the role of the dose and to explore the biological effects of haemofiltration we compared the effects of standard and high-volume haemofiltration in a peritonitis-induced model of porcine septic shock.
Design and setting:
Randomized, controlled experimental study.
Materials and methods:
Hyperdynamic sepsis secondary to peritonitis was induced in 21 anaesthetized and mechanically ventilated pigs. After 12 hours of sepsis the animals were randomized to receive either supportive treatment (control group, CON, n = 7), standard haemofiltration (HF, 35 ml/kg/h, n = 7) or high-volume haemofiltration (HVHF, 100 ml/kg/h, n = 7).
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 and after 12, 18, and 22 hours of peritonitis. Although fewer haemofiltration-treated animals required noradrenalin support (86%, 43% and 29% animals in the control, HF and HVHF groups, respectively), neither of the haemofiltration doses reversed the hyperdynamic circulation and lung dysfunction, or ameliorated alterations in the 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 moderate septic shock, early HVHF proved superior in preventing the development of septic hypotension. However, neither of the haemofiltration doses was capable of reversing the progressive disturbances in microvascular, metabolic, endothelial and lung function at least within the timeframe of this study and this model severity.
Keywords:
sepsis – haemofiltration – high volume haemofiltration – microcirculation – energy metabolism – oxidative stress
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