Effects of continuous veno-venous hemofiltration on dynamics of respiratory parameters in critically ill

Ioana Ghiţescu¹, Judit Eross², Roxana Simona Toma³, Ruxandra Copotoiu¹, V. Ghiţescu⁴, Sanda-Maria Copotoiu¹
1. Universitatea de Medicină şi Farmacie din Târgu Mureş, Disciplina Anestezie şi Terapie Intensivă; Clinica A.T.I. I, Spitalul Clinic Judeţean de Urgenţă Mureş
2. Spitalul Clinic Judeţean de Urgenţă Mureş, Clinica A.T.I. I
3. Institutul de Boli Cardiovasculare şi Transplant Târgu Mureş, Clinica A.T.I.
4. Institutul Medico-Militar, Târgu Mureş

Abstract

There are inconstant reports about the beneficial role of continuous veno-venous hemofiltration (CVVH) in improving oxygenation in septic patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).

Objectives: to asses the dynamics of the P/F (oxygen partial pressure/oxygen inspiratory concentration) and the need for PEEP in patients with ALI/ARDS under CVVH; the influence on oxygenation and 28 days survival of the dialysis dose and of the timing for initiation of CVVH.

Methods: 50 septic patients with ALI (n1 = 24) / ARDS (n2 = 26), mechanically ventilated, treated with CVVH. We observed the dynamics of P/F and need for PEEP at 24 h, 72 h and 7 days, the correlation of 28-days survival in ARDS with the “Ronco” dose (> 35 ml/kg/h) and the timing of CVVH initiation.

Results: Under CVVH, P/F described an ascending slope, while the need for PEEP a descending “mirrored image”. The improvement of P/F after 24 h was not influenced by dialysis doses over 35 ml/kg/h (p = 0.390), nor by early initiation of CVVH (p = 0.054). The 28-days survival in ARDS patients correlates only with the early CVVH initiation (p = 0.005).

Conclusions: CVVH improves oxygenation in septic patients with ALI/ARDS, independent of „Ronco” dialysis dose or early initiation. The 28-days survival in ARDS septic patients is improved by early initiation of CVVH.

Key words: continuous hemofiltration, septic patient, ALI, ARDS