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- Title
Continuous veno -venous hemofiltration for ARF in critically Ill patients.
- Authors
Lobo, Valentine; Joshi, Aniket; Joseph, Seema; Wandre, Sudhir; Norton, Clares; Joshi, Sayali; Wadia, F. F.
- Abstract
The mortality of critically ill patients who develop ARF in an ICU setting is extremely high (50-80%). Any mode of renal replacement therapy chosen should be able to achieve solute and water clearance while maintaining hemodynamic stability, have a positive effect on nutrition, and have low complication rates. Aim: To determine the efficacy and feasibility of Continuous Venovenous hemofiltration (CVVH) in critically ill patients with ARF. Inclusion criteria: Patients with ARF requiring 2 or more inotropes to maintain systolic blood pressure ≥100 mm of Hg. Failed or technically impossible hemodialysis or peritoneal dialysis. Time Period: July 2002 - June 2003. Materials and Methods: Polysulfone hemofilter 0.7m², [Aquamax (Edwards) or Multimat BL680 (BelIco).] Blood flow of 150-200 mI/minute (Travenol). Volumetrically controlled Ultrafiltration of ≥2000 ml per hour (Watson Marlowe) and replacement fluid infusion [(lnfusomat-P) post filter]. Anticoagulation: Heparin infusion or regional heparinisation. Results: 22 patients included, 6 with recent abdominal surgery. 11 underwent hemodiafiltration and hemofiltration each. Severe sepsis was present in 21, and DIC in 18.5 patients were on immunosuppressive therapy. The time from ICU admission to the start of CVVH was 114 ± 88.08 hours. The duration of CVVH was 35.93 ± 20.91 hours, (range 11 to 84 hours). The mean hourly ultrafiltration of 93.72 ± 65.57 ml and total ultrafiltration of 3955.55 ± 4132 ml was tolerated by all patients without limiting hypotension. The APACHE II scores had significantly worsened between admission (22.5 ± 6.71) to starting CVVH (36.05 ± 4.08), [P≤0.001]. The daily costs of CVVH were Rs. 5000 compared to Rs. 2150 for PD and Rs. 1500 for extended daily dialysis Conclusions: CVVH was effective in providing metabolic correction in ARF, in the setting of multi-organ failure.. It is technically feasible even when conventional hemodialysis or peritoneal dialysis cannot be performed.
- Subjects
BLOOD filtration; CATASTROPHIC illness; HEMODIALYSIS; THERAPEUTICS; BLOOD pressure measurement; BLOOD flow; HEPARIN
- Publication
Indian Journal of Critical Care Medicine, 2004, Vol 8, Issue 3, p148
- ISSN
0972-5229
- Publication type
Article