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Romuald Lango, Janina Suchorzewska, Jan Rogowski, Janusz Siebert, Chris P. Stoutenbeek, Heleen M. Oudemans-van Straaten, Durk F. Zandstra
Med Sci Monit 1998; 4(3): CR458-464
The risk of circulatory system depression during the application of new kidney-replacement methods is nowadays considerably lower. It is suggested that haemofiltration exerts a favourable influence upon haemodynamics. The aim of the study was the evaluation of circulatory system stability during high volume continuous veno-venous haemofiltration in patients with acute renal failure after operations in cardiopulmonary bypass, or in the course of acute myocardial infarction.The group of 14 patients with acute renal failure after cardiosurgery or in the course of myocardial infarction underwent the examinations of haemodynamics on the basis of the measurements of stroke volume with thermodilution, during the first 24 hours of high volume continuous veno-venous haemofiltration. The cellulose triacetate filter of 1.9 m2, area and maximum size of penetrating particles of 50000 Daltones was applied.After 24 hours of haemofiltration, the increase of arterial blood pressure was observed, in the circumstances of identical supply of inotropic drugs and identical left and right ventricular filling pressures. The values of both systemic and pulmonary vascular resistance, observed after 12, 18 and 24 hours were higher than the initial values. 6 hours after the beginning of haemofiltration, heart rate increased temporarily, which was associated with a slight decrease of stroke index. The latter as well as cardiac index were slightly lower after 12 hours of haemofiltration when compared with their initial values. Apart from higher systolic, diastolic and mean arterial blood pressure after 24 hours of haemofiltration, there was a statistically insignificant increase of left ventricular stroke work index. High volume continuous veno-venous haemofiltration in patients with multiple organ failure as a result of cardiac insufficiency following the operations in cardiopulmonary bypass or in the course of acute myocardial infarction neither intensifies nor leads to the disorders from circulatory system. The increase of arterial blood pressure after 24 hours of haemofiltration with unchanged values of left and right ventricle filling pressure and a continuous supply of inotropic drugs, suggests that its cause may be the removal of inflammatory reaction mediators and substances of cardiodepressive activity.The method of haemofiltration applied during the present study is well tolerated haemodynamically in patients with multiple organ failure after cardiosurgery or in the course of myocardial infarction.