Continuous venovenous hemofiltration decreases mortality and ameliorates acute lung injury in canine model of severe salt water drowning

Abstract

BackgroundPulmonary edema is an important cause of complications and death in severe drowning. Continuous veno-venous hemofiltration (CVVH) may reduce pulmonary edema and thus may be a treatment modality for severe sea water drowning resuscitation.Methos20 dogs were anesthetized and tracheally intubated. 10 ml/kg of sea water was infused into trachea in a minute. All animals developed signs of respiratory distress and severe hypoxia (PaO2 < 40 mmHg) within 15 minutes after infusion. They were then mechanical ventilated and randomized to receive either CVVH (n = 10) or no additional treatment (control, n = 10) and followed over 4 hours. Arterial gas, hemodynamic parameters, and the levels of circulating inflammatory cytokines including interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor α (TNFα) were determined. Additionally, blood endothelin and the levels of oxidative stress in lung were measured at sacrifice.Results5 animals in the control group (50 %) died within 4 hours after sea water aspiration, while 10 animals received CVVH all survived (p < 0.05). Importantly, CVVH significantly improved blood gas exchange as evidenced by higher PaO2, normal oxygen saturation, and no carbon dioxide retention after 3 hour of CVVH, while also correcting against acidosis. Levels of circulating IL-6, IL-8, and TNFα were elevated in control but not in CVVH group (p < 0.01). CVVH also reduced plasma endothelin and alleviated oxidative stress. Histology examination further revealed reductions in pulmonary alveolar injury, blood congestion, and inflammation by CVVH.Discussion and conclusionsCVVH decreased mortality and pulmonary injury and largely maintained hemodynamic and acid-base balance in animals with severe sea water drowning and thus, may be added as a new measure to aid in resuscitation from severe sea water drowning.Trial registrationAnimal protocol number: FZG0001859 http://www.fzzyy.com.

Effects of continuous renal replacement therapy on inflammation-related anemia, iron metabolism and prognosis in sepsis patients with acute kidney injury

“…[3] Furthermore, CRRT may ameliorate the hypoxemia and acute lung injury, thereby decreasing erythropoietin production. [16] Meanwhile, CRRT may remove pro-infl ammatory cytokines, thereby increasing erythropoietin production. Considering the inconsistent effects of CRRT on erythropoietin production, it was not surprising to observe that the CRRT failed to affect the serum erythropoietin in sepsis patients in the present study.…”

Histopathological Differentiation of Drowning in Freshwater and Saltwater in Rats: Forensic Point of View

“…Anesthetization and intratracheally instilled salt or freshwater in dogs or rabbits are the most common methods used to explore the drowning pathogenesis (Chen et al, 2016). However, many obvious drawbacks have been identified in intratracheally instilled water method.…”

Continuous Veno-Venous Hemofiltration (CVVH) Improves Iron Metabolism Disorders in Patients with Sepsis：A Single-Center Prospective Cohort Study

“…Plasma EPO is usually increased in response to anemia and hypoxemia, whereas the production of EPO is compromised by impaired renal function (which decreases EPO production) and pro-in ammatory cytokines (such as TNF-α and IL-6, which inhibits EPO production) in patients with sepsis [4,32]. On the one hand, CVVH may ameliorate hypoxemia and acute lung injury, thus decreasing the production of EPO [33]. However, clearance of proin ammatory cytokines by CVVH may increase the production of EPO.…”