Clinical Effects of Pulse High‐Volume Hemofiltration on Severe Acute Pancreatitis Complicated With Multiple Organ Dysfunction Syndrome

Abstract

To evaluate the effects of pulse high-volume hemofiltration (PHVHF) on severe acute pancreatitis (SAP) with multiple organ dysfunction syndrome (MODS). Thirty patients were divided into two groups: PHVHF group and continuous venovenous hemofiltration (CVVH) group. They were evaluated in terms of clinical symptoms, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score, simplified acute physiology (SAPS) II score and biochemical changes. The levels of IL-6, IL-10 and TNF-α in plasma were assessed by ELISA before and after treatment. The doses of dopamine used in shock patients were also analyzed. In the two groups, symptoms were markedly improved after treatment. Body temperature (BT), breath rate (BR), heart rate (HR), APACHE II score, SOFA score, SAPS II score, serum amylase, white blood cell count and C-reactive protein were decreased after hemofiltration (P < 0.05). The PHVHF group was superior to the CVVH group, especially in APACHE II score, CRP (P < 0.01), HR, temperature, SOFA score and SAPS II score (P < 0.05). The doses of dopamine for shock patients were also decreased in the two groups (P < 0.05), with more reduction in the PHVHF group than the CVVH group (P < 0.05). The levels of IL-6, IL-10 and TNF-α decreased (P < 0.05) in the PHVHF group more significantly than the CVVH group (P < 0.01). PHVHF appears to be superior to CVVH in the treatment of SAP with MODS.

Effects of High Volume Haemodiafiltration on Inflammatory Response Profile and Microcirculation in Patients with Septic Shock

“…We found significant decrease of norepinephrine dose requirement during extended high volume (median 123 mL/kg/h) intermittent haemodiafiltration in patients with septic shock despite negative fluid balance in most patients. This finding is in line with other experimental [ 17 ] and clinical studies with different modalities of high volume haemofiltration [ 7 – 11 , 18 ]. However, a recent randomized multicentre study, comparing continuous haemofiltration in the dose of 35 mL/kg/h to 70 mL/kg/h [ 12 ], did not show any haemodynamic or survival benefit from higher filtration volumes, yet the study was underpowered, recruiting 140 patients instead of 460 required from power calculation.…”

Effect of pulse high-volume hemofiltration on Toll-like receptor in patients with severe sepsis

“…In 2004, PHVHF technology was suggested by Brendolan to solve the issue (19). Previous findings showed that for treatment of severe sepsis, PHVHF can improve hemodynamics, decrease inflammatory mediator response, and restore the immune balance (20–23). Our results showed that, PHVHF can improve clinical symptoms of patients with severe sepsis, and reduce the APACHE II score.…”

Early Continuous Veno-Venous Hemofiltration Is Effective in Decreasing Intra-Abdominal Pressure and Serum Interleukin-8 Level in Severe Acute Pancreatitis Patients with Abdominal Compartment Syndrome

“…Studies show that 11-30% of SAP patients have ACS, which has a high mortality rate of 30-60%, despite significant improvement in treatment due to the better understanding of the pathophysiology of disease, early aggressive fluid resuscitation, and timely surgical intervention. At present, it is well accepted that SAP patients with SIRS have a high risk of developing ACS [19]. Blood levels of various cytokines are elevated in SAP and among them, the blood level of IL-8 as one of main inflammatory cytokines has been reported to reflect the severity of SAP.…”