Hemofiltration in a Cardiac Intensive Care Unit

Tsang, Geoffrey; Khan, Iftikar; Dar, Mudassa; Clayton, Diane; Waller, David; Patel, Ramesh

doi:10.1097/00002480-199609000-00079

Cited by 14 publications

(5 citation statements)

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“…CVVH has several disadvantages, including intensive nursing requirements, continuous anticoagulation, patient immobility, and expense [5,7]. The cost difference between CVVH and IHD in one study was $261 per treatment day [15].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, it is important to analyse the results periodically so as to find out predictors of mortality, which may help to predict outcome and help proper allocation of resources. Tsang and colleagues found no survivors when the cardiac index was less than 1.7 l/m 2 and adrenaline requirements was more than 30 mg/min before starting continuous hemofiltration, although only 60% of patients had cardiac output monitored there [7]. Bent and colleagues on multivariate analysis found hypotension, reoperation, acidosis and neurological dysfunction to be predictors of adverse outcome [4].…”

Section: Discussionmentioning

confidence: 99%

“…Early and intensive application of CVVH as a strategy has also helped to improve the outcome [3,4]. CVVH however has not been without criticism because of the perception that it is costly, resource intensive and in reality may not improve the outcome [5,7]. There is also need to predict which patients would benefit from such an intensive application of CVVH so as to use it more rationally [8].…”

Section: Introductionmentioning

confidence: 99%

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Early and intensive continuous veno-venous hemofiltration for acute renal failure after cardiac surgery

Bapat

Sabetai

Roxburgh

et al. 2004

Interactive Cardiovascular and Thoracic Surgery

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Various forms of renal replacement therapies are available to treat acute renal failure (ARF) after cardiac surgery. The objective of this study was to assess the incidence of ARF developing postoperatively necessitating continuous veno-venous hemofiltration (CVVH) in adult patients requiring cardiopulmonary bypass (CPB), to determine the factors which influence the outcome in these patients and to assess the outcome following the use of early and intensive CVVH. During the study period, i.e. August 2000 to July 2002, 2355 adult patients underwent surgery under CPB, of whom 159 (6.7%) developed renal failure (creatinine >200 micromol/l) and 116 (5%) needed CVVH. Patients excluded were those who died within 24 h and those who underwent coronary artery bypass grafting without utilising CPB, thoracoabdominal aneurysm operations and pericardial surgery. Average age, Parsonnet score and Euroscore in the study population were 69.9 years, 21 and 7.70, respectively. Of the 116, 45 died in the intensive care unit (38.8% mortality). Relatively more non-survivors suffered from diabetes and preoperative renal dysfunction (P<0.05). Adverse outcome was also more likely if patient suffered from postoperative cardiac failure or had gastrointestinal complications or had more than two organ systems failing (P<0.05). Mortality was 100% if hepatic failure ensued.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early and intensive continuous veno-venous hemofiltration for acute renal failure after cardiac surgery

Bapat

Sabetai

Roxburgh

et al. 2004

Interactive Cardiovascular and Thoracic Surgery

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“…This finding suggests that hemofiltration does not reduce the therapeutic actions of these medications. In early studies in which hemofiltration was applied late (>8 days) and at rates ≤1 l per hour to treat postoperative hypervolemia, mortality rates after treatment have ranged between 52 and 87.5% [87][88][89]. In contrast, early and intensive application of hemofiltration in heart surgery patients with volume overload and renal dysfunction was associated with lower posttreatment mortality rates ranging from 40 to 60% [82,90].…”

Section: Role Of Ultrafiltration In Heart Failure Patients Undergoingmentioning

confidence: 99%

Extracorporeal Fluid Removal in Heart Failure Patients

Costanzo

Agostoni

Marenzi

2010

Contributions to Nephrology

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More than one million hospitalizations occur annually in the US because of heart failure (HF) decompensation caused by fluid overload. Congestion contributes to HF progression and mortality. Apart from intrinsic renal insufficiency, venous congestion, rather than a reduced cardiac output, may be the primary hemodynamic factor driving worsening renal function in patients with acutely decompensated HF. According to data from large national registries, approximately 40% of hospitalized HF patients are discharged with unresolved congestion, which may contribute to unacceptably high rehospitalization rates. Although diuretics reduce the symptoms and signs of fluid overload, their effectiveness is reduced by excess salt intake, underlying chronic kidney disease, renal adaptation to their action and neurohormonal activation. In addition, the production of hypotonic urine limits the effectiveness of loop diuretics in reducing total body sodium. Ultrafiltration is the mechanical removal of fluid from the vasculature. Hydrostatic pressure is applied to blood across a semipermeable membrane to separate isotonic plasma water from blood. Because solutes in blood freely cross the semipermeable membrane, large amounts of fluid can be removed at the discretion of the treating physician without affecting any change in the serum concentration of electrolytes and other solutes. Ultrafiltration has been used to relieve congestion in patients with HF for almost four decades. In contrast to the adverse physiological consequences of loop diuretics, numerous studies have demonstrated favorable responses to ultrafiltration. Such studies have shown that removal of large amounts of isotonic fluid relieves symptoms of congestion, improves exercise capacity, improves cardiac filling pressures, restores diuretic responsiveness in patients with diuretic resistance, and has a favorable effect on pulmonary function, ventilatory efficiency, and neurohormonal activation. Ultrafiltration is the only fluid removal strategy shown to improve outcomes in randomized controlled trials of patients hospitalized with decompensated HF.

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“…The impact of new techniques such as continuous haemodiafiltration has not yet been studied appropriately, 111 but the results of retrospective analysis are poor. 122 Up to now, mortality has been more dependent upon patient-related factors than the form of renal replacement therapy. 123 …”

Section: General Remarksmentioning

confidence: 99%