Isolated ultrafiltration in cardiogenic pulmonary edema

Susini, G.; Zucchetti, Martina; Bortone, Franco; Salvi, Luca; Cipolla, Carlo M.; Rimondini, Andrea; Sisillo, Erminio

doi:10.1097/00003246-199001000-00004

Cited by 40 publications

(10 citation statements)

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“…While the reducing effect of ultrafiltration on EVLWI in patients with cardiogenic pulmonary oedema is well known [35,36], this effect has been described but is less clear in animal models and patients with ALI or ARDS [36,37]. However, although some results have been conflicting, zero balance continuous haemofiltration may improve cardiopulmonary function and reduce pulmonary oedema in these patients, perhaps by removing pro-inflammatory cytokines [38].…”

Section: Discussionmentioning

confidence: 99%

Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients

Laet

Deeren

Schoonheydt

et al. 2012

Ann. Intensive Care

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BackgroundLittle is known about the effects of renal replacement therapy (RRT) with fluid removal on intra-abdominal pressure (IAP). The global end-diastolic volume index (GEDVI) and extravascular lung water index (EVLWI) can easily be measured bedside by transpulmonary thermodilution (TPTD). The aim of this study is to evaluate the changes in IAP, GEDVI and EVLWI in critically ill patients receiving slow extended daily dialysis (SLEDD) or continuous venovenous haemofiltration (CVVH) with the intention of net fluid removal.MethodsWe performed a retrospective cohort study in ICU patients who were treated with SLEDD or CVVH and in whom IAP was also measured, and RRT sessions were excluded when the dose of vasoactive medication needed to be changed between the pre- and post-dialysis TPTD measurements and when net fluid loss did not exceed 500 ml. The TPTD measurements were performed within 2 h before and after SLEDD; in case of CVVH, before and after an interval of 12 h.ResultsWe studied 25 consecutive dialysis sessions in nine patients with acute renal failure and cardiogenic or non-cardiogenic pulmonary oedema. The GEDVI and EVLWI values before dialysis were 877 ml/m² and 14 ml/kg, respectively. Average net ultrafiltration per session was 3.6 l, with a net fluid loss 1.9 l. The GEDVI decreased significantly during dialysis, but not more than 47.8 ml/m² (p = 0.008), as also did the EVLWI with 1 ml/kg (p = 0.03). The IAP decreased significantly from 12 to 10.5 mmHg (p < 0.0001).ConclusionsNet fluid removal by SLEDD or CVVH in the range observed in this study decreased IAP, GEDVI and EVLWI in critically ill patients although EVLWI reduction was modest.

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Section: Discussionmentioning

confidence: 99%

Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients

Laet

Deeren

Schoonheydt

et al. 2012

Ann. Intensive Care

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“…[4] In patients with kidney disease or those refractory to fluid restriction or drug therapy, hemodialysis is the only option in decreasing intravascular volume. [5]…”

Section: Discussionmentioning

confidence: 99%

Frequency of hypoxic events in patients on a mechanical ventilator

Mahmood

Chaudry

Azam

et al. 2013

Int J Crit Illn Inj Sci

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Background:Mechanical ventilation is an important tool in the management of respiratory failure in the critically ill patient. Although mechanical ventilation can be a life-saving intervention, it is also known to carry several side-effects and risks. Adequate oxygenation is one of the primary goals of mechanical ventilation. However, while on mechanical ventilation, patients frequently experience hypoxic events resulting from various causes, which need to be properly evaluated and treated.Materials and Methods:Data were obtained by prospectively reviewing all intensive care admissions during the period from March 2009 to March 2010 at a 651-bed urban medical center. Patients who developed hypoxemia (oxygen saturation ≤88% and a PaO2≤60 torrs) while on mechanical ventilation were investigated for the cause of hypoxic event.Results:During the study period, 955 patients required mechanical ventilation from which 79 developed acute hypoxia. The causes of acute hypoxia in decreasing order of occurrences were pulmonary edema, atelectasis, pneumothorax, pneumonia, ARDS, endotracheal tube malfunction, airway bleeding, and pulmonary embolism.Conclusions:Appropriate evaluation of all hypoxic events must begin at the bedside. A step-by-step approach must include a thorough physical examination. Evaluation of the endotracheal tube can immediately reveal dislodgement, bleeding, and secretions. Correlation of physical examination findings with those on chest radiograph is essential. Each hypoxic event requires a different intervention depending on its etiology. Instead of simply increasing the fraction of oxygen in the inspired air to overcome hypoxia, a concerted effort in appropriate problem solving can reduce the likelihood of an incorrect diagnosis and management response.

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“…In patients receiving ultrafiltration, however, peak Vo, and exercise tolerance time were significantly raised and the score for lung water was reduced at four, 30, and 90 days after ultrafiltration. 13 (2) 13 (2) 13 (2) 14 (1) *p < 0-02 Compared with corresponding control group value.…”

Section: Functional Capacitymentioning

confidence: 92%

Sustained cardiac diastolic changes elicited by ultrafiltration in patients with moderate congestive heart failure: pathophysiological correlates.

Pepi

Marenzi

Agostoni

et al. 1993

Heart

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Objective-To investigate the pathophysiological (cardiac fimction and physical performance) significance of clinically silent interstitial lung water accumulation in patients with moderate heart failure; to use isolated ultrafiltration as a means of extravascular fluid reabsorption. Design-Echocardiographic, Doppler, chest x-ray evaluations, and cardiopulmonary tests at baseline, soon after ultrafiltration (veno venous extracorporeal circuit), and four days, one month, and three months later. Setting-University institute of cardiology. Subjects-24 patients with heart failure due to idiopathic dilated cardiomyopathy or ischaemic myocardial disease with sinus rhythm and ejection fraction less than 35%. Twelve were randomised to ultrafiltration and 12 were taken as controls. Main outcome measures-Left ventricular systolic function (from ultrasonography); Doppler evaluation of mitral, tricuspid, and aortic flow and echoDoppler determination of cardiac output; radiological score of extravascular lung water; right and left ventricular filling pressures; oxygen consumption at peak exercise and exercise tolerance time in cardiopulmonary tests. Results-Soon after ultrafiltration (1976 (760) ml of fluid removed) the following was observed: a reduction in radiological score of extravascular lung water (from 15(1) to 9(1)) and of right (from 7*1 (2.3) to 2-3 (1.7) mm Hg) and left (from 17*6 (8-8) to 9-S (6.4) mm Hg) ventricular filling pressures; an increase in oxygen consumption at peak exercise (from (3.3) to 17-6 (2) mllminlkg) and of tolerance time (from 444 (138)

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Isolated ultrafiltration in cardiogenic pulmonary edema

Cited by 40 publications

References 0 publications

Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients

Renal replacement therapy with net fluid removal lowers intra-abdominal pressure and volumetric indices in critically ill patients

Frequency of hypoxic events in patients on a mechanical ventilator

Sustained cardiac diastolic changes elicited by ultrafiltration in patients with moderate congestive heart failure: pathophysiological correlates.

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