High volume hemofiltration improves right ventricular function in endotoxin-induced shock in the pig

Abstract

This study assessed the influence of continuous high volume hemofiltration on right ventricular function of pigs with endotoxin induced shock. Eighteen anesthetized and ventilated pigs were studied for 240 min after the start of infusion of 0.5 mg/kg endotoxin over 30 min. Right ventricular ejection fraction (RVEF) was measured by rapid response thermodilution technique. After endotoxin infusion, the pigs were randomly divided into 3 groups: group 1 as a control group, receiving endotoxin only, group 2 to observe the effects of zero balance high volume veno-venous hemofiltration with removal of ultrafiltrate at a rate of 6000 ml/h, and group 3 to evaluate the effect of the extracorporeal circuit itself on RVEF. The decline of RVEF in group 2 was less than in group 1 (0.04 +/- 0.02 vs 0.21 +/- 0.03 (mean +/- SEM); p less than 0.001). The decline of RVEF in group 3 (0.24 +/- 0.02) was more pronounced than that in group 1 (p less than 0.05). The differences in the course of RVEF between group 1 and group 2 could not be explained by differences in heart rate, preload or afterload. Cardiac output and mean arterial pressure were significantly higher in group 2 than in group 1 (p less than 0.01). It is concluded that in this model, high volume hemofiltration improves RVEF and cardiac performance by removal of vasoactive mediators, responsible for myocardial depression.

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

“…35 ml/kg per hour. Although our observation corroborates recent reports, both from animal [16,19,20,27] and clinical [9][10][11][12][13][14] trials, demonstrating a favorable effect on systemic haemodynamic, an ultrafiltration rate of 100 ml/ kg per hour failed to be superior over 35 ml/kg per hour in its capability to ameliorate disturbances in other mutually independent biological systems. These results could indicate, among other things, that the value of haemodynamic improvement as a surrogate marker for efficacy of haemofiltration might be ambiguous.…”

“…Data are median and 25th and 75th quartiles group; (2) despite favorable effects on vasopressor requirements, neither of the haemofiltration doses beneficially modulated the sepsis-induced alterations in microcirculatory perfusion and energy metabolism, endothelial dysfunction and oxidative stress. The reduced need for vasopressor support observed in both haemofiltration groups is consistent with previous experimental [16,19,20,27] and human studies [9,11,13,14]. The unchanged cardiac performance and comparable cardiac preload suggest an influence of haemofiltration on pathways implicated in the control of vascular tone, such as cytokine-driven iNOS-generated overproduction of nitric oxide or opening of ATP-sensitive potassium channels [28,29].…”

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

“…35 ml/kg per hour. Although our observation corroborates recent reports, both from animal [16,19,20,27] and clinical [9][10][11][12][13][14] trials, demonstrating a favorable effect on systemic haemodynamic, an ultrafiltration rate of 100 ml/ kg per hour failed to be superior over 35 ml/kg per hour in its capability to ameliorate disturbances in other mutually independent biological systems. These results could indicate, among other things, that the value of haemodynamic improvement as a surrogate marker for efficacy of haemofiltration might be ambiguous.…”

“…Data are median and 25th and 75th quartiles group; (2) despite favorable effects on vasopressor requirements, neither of the haemofiltration doses beneficially modulated the sepsis-induced alterations in microcirculatory perfusion and energy metabolism, endothelial dysfunction and oxidative stress. The reduced need for vasopressor support observed in both haemofiltration groups is consistent with previous experimental [16,19,20,27] and human studies [9,11,13,14]. The unchanged cardiac performance and comparable cardiac preload suggest an influence of haemofiltration on pathways implicated in the control of vascular tone, such as cytokine-driven iNOS-generated overproduction of nitric oxide or opening of ATP-sensitive potassium channels [28,29].…”

Large‐Pore Membrane Hemofiltration Increases Cytokine Clearance and Improves Right Ventricular–Vascular Coupling During Endotoxic Shock in Pigs

“…LPHF did not improve the mean systemic arterial pressure and cardiac output, which remained similar in both groups. These results are in accordance with those of Stein et al (9), but they are in opposition with those of Grootendorst, who showed an increase in the mean arterial pressure and cardiac output in endotoxic pigs receiving continuous high‐volume hemofiltration (8,10). Lee et al found no significant increase in the mean arterial pressure in endotoxic pigs receiving LPHF (100 kDa pore size membrane), although it increased survival rate (11).…”

Comparison of polyacrylonitrile (AN69) and polysulphone membrane during hemofiltration in canine endotoxic shock

“…In our study, the decrease in plasma nitrite/ nitrate levels with CVVH argues against the involvement of nitric oxide in the decrease in pulmonary and systemic vascular resistance seen during CVVH. As in other experiments using the endotoxic shock model, we also found that hemofiltration mainly improved cardiac function (6,10,12,16), explaining the decrease in SVR during hemofiltration.…”

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

“…35 ml/kg per hour. Although our observation corroborates recent reports, both from animal [16,19,20,27] and clinical [9][10][11][12][13][14] trials, demonstrating a favorable effect on systemic haemodynamic, an ultrafiltration rate of 100 ml/ kg per hour failed to be superior over 35 ml/kg per hour in its capability to ameliorate disturbances in other mutually independent biological systems. These results could indicate, among other things, that the value of haemodynamic improvement as a surrogate marker for efficacy of haemofiltration might be ambiguous.…”

“…Data are median and 25th and 75th quartiles group; (2) despite favorable effects on vasopressor requirements, neither of the haemofiltration doses beneficially modulated the sepsis-induced alterations in microcirculatory perfusion and energy metabolism, endothelial dysfunction and oxidative stress. The reduced need for vasopressor support observed in both haemofiltration groups is consistent with previous experimental [16,19,20,27] and human studies [9,11,13,14]. The unchanged cardiac performance and comparable cardiac preload suggest an influence of haemofiltration on pathways implicated in the control of vascular tone, such as cytokine-driven iNOS-generated overproduction of nitric oxide or opening of ATP-sensitive potassium channels [28,29].…”

Large‐Pore Membrane Hemofiltration Increases Cytokine Clearance and Improves Right Ventricular–Vascular Coupling During Endotoxic Shock in Pigs

“…LPHF did not improve the mean systemic arterial pressure and cardiac output, which remained similar in both groups. These results are in accordance with those of Stein et al (9), but they are in opposition with those of Grootendorst, who showed an increase in the mean arterial pressure and cardiac output in endotoxic pigs receiving continuous high‐volume hemofiltration (8,10). Lee et al found no significant increase in the mean arterial pressure in endotoxic pigs receiving LPHF (100 kDa pore size membrane), although it increased survival rate (11).…”

Comparison of polyacrylonitrile (AN69) and polysulphone membrane during hemofiltration in canine endotoxic shock

“…In our study, the decrease in plasma nitrite/ nitrate levels with CVVH argues against the involvement of nitric oxide in the decrease in pulmonary and systemic vascular resistance seen during CVVH. As in other experiments using the endotoxic shock model, we also found that hemofiltration mainly improved cardiac function (6,10,12,16), explaining the decrease in SVR during hemofiltration.…”

High versus standard-volume haemofiltration in hyperdynamic porcine peritonitis: effects beyond haemodynamics?

“…35 ml/kg per hour. Although our observation corroborates recent reports, both from animal [16,19,20,27] and clinical [9][10][11][12][13][14] trials, demonstrating a favorable effect on systemic haemodynamic, an ultrafiltration rate of 100 ml/ kg per hour failed to be superior over 35 ml/kg per hour in its capability to ameliorate disturbances in other mutually independent biological systems. These results could indicate, among other things, that the value of haemodynamic improvement as a surrogate marker for efficacy of haemofiltration might be ambiguous.…”

“…Data are median and 25th and 75th quartiles group; (2) despite favorable effects on vasopressor requirements, neither of the haemofiltration doses beneficially modulated the sepsis-induced alterations in microcirculatory perfusion and energy metabolism, endothelial dysfunction and oxidative stress. The reduced need for vasopressor support observed in both haemofiltration groups is consistent with previous experimental [16,19,20,27] and human studies [9,11,13,14]. The unchanged cardiac performance and comparable cardiac preload suggest an influence of haemofiltration on pathways implicated in the control of vascular tone, such as cytokine-driven iNOS-generated overproduction of nitric oxide or opening of ATP-sensitive potassium channels [28,29].…”

Large‐Pore Membrane Hemofiltration Increases Cytokine Clearance and Improves Right Ventricular–Vascular Coupling During Endotoxic Shock in Pigs

“…LPHF did not improve the mean systemic arterial pressure and cardiac output, which remained similar in both groups. These results are in accordance with those of Stein et al (9), but they are in opposition with those of Grootendorst, who showed an increase in the mean arterial pressure and cardiac output in endotoxic pigs receiving continuous high‐volume hemofiltration (8,10). Lee et al found no significant increase in the mean arterial pressure in endotoxic pigs receiving LPHF (100 kDa pore size membrane), although it increased survival rate (11).…”

Comparison of polyacrylonitrile (AN69) and polysulphone membrane during hemofiltration in canine endotoxic shock

“…In our study, the decrease in plasma nitrite/ nitrate levels with CVVH argues against the involvement of nitric oxide in the decrease in pulmonary and systemic vascular resistance seen during CVVH. As in other experiments using the endotoxic shock model, we also found that hemofiltration mainly improved cardiac function (6,10,12,16), explaining the decrease in SVR during hemofiltration.…”