Influence of Zero-Balanced Hemofiltration on the Course of Severe Experimental Pancreatitis in Pigs

Abstract

ObjectiveTo examine the impact of continuous venovenous hemofiltration (CVVH) on the course of experimental pancreatitis in pigs. Summary Background DataThe activation of different mediator cascades is assumed to trigger multiple organ dysfunction or failure during necrotizing pancreatitis. CVVH has been suggested to be beneficial in those instances by eliminating several inflammatory mediators released in the circulation. MethodsPancreatitis was induced by a combined intraductal injection of sodium taurocholate and enterokinase. Control group animals received no treatment after induction. A second group underwent "therapeutic" CVVH after a 20% decline of mean arterial pressure. In the third group, "prophylactic" CVVH was started simultaneously with the induction of pancreatitis.The concentrations of tumor necrosis factor-alpha, transforming growth factor-beta1, kinin, and phospholipase A2 were measured at different time points in blood (preand postfilter) and in the hemofiltrate to calculate the respective sieving coefficients that reflect most accurately the plasma clearance of mediators by CVVH. ResultsSurvival time was significantly prolonged both by therapeutic and prophylactic CVVH; it was more pronounced in the latter. CVVH did not influence the increase in transforming growth factor concentrations. However, 6 hours after induction, the increases of plasma concentrations of tumor necrosis factor, phospholipase, and kinin were significantly weakened by CVVH compared with controls. In the treatment groups, the plasma concentrations of tumor necrosis factor and phospholipase showed a significant negative correlation with the respective sieving coefficients, which decreased in the later course of the experiments. ConclusionsExpenmental necrotizing pancreatitis was associated with a tremendous increase of plasma concentrations of tumor necrosis factor, phospholipase, and kinin. The effective removal of these mediators by CVVH resulted in significantly improved survival time. Animals that received prophylactic CVVH had a longer survival period than those in which CVVH was started after clinical impairment. The decreasing efficiency of CVVH in eliminating inflammatory mediators in the later course of the experiments suggested that the filter membranes were compromised by long-term application. These findings provide further evidence that CVVH offers therapeutic options even in the absence of conventional indications for blood-purifying treatments.Because appropriate fluid resuscitation has been accepted for early therapy in acute pancreatitis, hypovolemic shock is no longer responsible for deaths from this disease. However, the development of extensive necrosis, resulting in The aim of the present study was therefore to evaluate the effect of continuous venovenous hemofiltration (CVVH) on the plasma concentrations and activities of inflammatory mediators in a porcine model of severe necrotizing pancreatitis. Moreover, we investigated whether the removal of pancreatitis-related mediators by CVVH would result in a...

Cost-effectiveness analysis of early veno-venous hemofiltration for severe acute pancreatitis in China

“…This results in an imbalance between pro-and anti-inflammatory cytokines, resulting in the development of SIRS. Some mediators, such as TNF-alpha, phospholipase, and kinin, are increased greatly in animal models of SAP [9] , and some studies have shown that there is a significant correlation between the serum levels of IL-1-beta, IL-6, IL-8, IL-10 and IL-11 and the severity of acute pancreatitis [24][25][26][27] . Animal studies have shown that early blockade of the cytokine cascade at the level of the IL-1 receptor significantly decreases the severity of pancreatitis and intrinsic pancreatic damage, as well as the mortality from SAP [28,29] .…”

“…Alternatively, VVH www.wjgnet.com may directly inhibit the cells that contribute to the systematic response [8] . The use of continuous veno-venous hemofiltration (CVVH) has been assessed in a animal model of SAP and was found to significantly improve the survival time, when used both for therapeutic and prophylactic treatment, especially the latter [9] . However, the efficiency of treatment decreased with continuing use of CVVH, suggesting that the filter membranes were compromised by long-term application [9] .…”

“…The use of continuous veno-venous hemofiltration (CVVH) has been assessed in a animal model of SAP and was found to significantly improve the survival time, when used both for therapeutic and prophylactic treatment, especially the latter [9] . However, the efficiency of treatment decreased with continuing use of CVVH, suggesting that the filter membranes were compromised by long-term application [9] . The current consensus in Japan is to start CVVH soon after the onset of SAP, and to use it continuously for 3-14 d, because reduction in the chemical mediators, and improvement in the respiratory function and the incidence of MODS were more obvious if the treatment was started early rather than at a late stage [10] .…”

Somatosensory evoked potentials as predictor of systemic inflammatory response syndrome in pigs?

“…For this a model of experimental pancreatitis [8] mediating SIRS or even septic disease associated with hemodynamic insufficiencies was used. However, classical criteria of systemic inflammatory disease in humans such as body temperature higher than 39.0°C, tachycardia, tachypnea, and leukocystia or leukopenia are in the physiological range in animals [9,10].…”

Methylene blue improves hemodynamic shock but increases lipoperoxidation in severe acute pancreatitis pig model

“…1 body weight during a 1 minute period was performed as described also were. 10,11 MB infusion. MB (Merck Diagnostica, Darmstadt, Germany) infusion was carried through an initial dose of 2mg.kg-1 body weight diluted in 20 ml of 0,9% sodium chloride solution followed by a maintenance dose of 2 mg.kg-1 body weight.h-1 was done by a continuous intravenous infusion throughout the experiment.…”