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The effect of intensive plasma water exchange by hemofiltration on hemodynamics and soluble mediators in canine endotoxemia

Bellomo, R and Kellum, JA and Gandhi, CR and Pinsky, MR and Ondulik, B (2000) The effect of intensive plasma water exchange by hemofiltration on hemodynamics and soluble mediators in canine endotoxemia. American Journal of Respiratory and Critical Care Medicine, 161 (5). 1429 - 1436. ISSN 1073-449X

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High volume hemofiltration (HVHF) (200 ml/kg/h) improves hemodynamics in experimental septic shock but is difficult to apply clinically. Accordingly, we studied whether less intensive HVHF (80 ml/kg/h) can still improve hemodynamics in experimental septic shock. We also investigated its effect on the serum concentrations of several inflammatory mediators, including endothelin (ET-1), endotoxin (LPS), tumor necrosis factor-α (TNF-α), and 6- keto prostaglandin F(1α) (6-kepto PGF(1α)). Sixteen anesthetized dogs were connected to a continuous veno-venous hemofiltration (CVVH) (filtration: 80 ml/kg/h) or sham circuit and endotoxin (0.5 mg/kg) was infused intravenously over 5 min. Hemodynamic variables were measured at baseline and at 15, 45, 90, and 180 min. The major hemodynamic finding was that endotoxin-induced hypotension was significantly attenuated by intensive CVVH (p < 0.04). Changes in cardiac output and right ventricular ejection fraction were equal in both groups. ET-1 levels, but not LPS, TNF-α, or 6-keto PGF(1α), were lower during CVVH (p = 0.042). Endotoxin or TNF-α were not found in the ultrafiltrate. Median clearances of ET-1 and 6-keto PGF(1α) during intensive CVVH were 8.8 and 25.9 ml/m, respectively. We conclude that intensive CVVH attenuates the early component of endotoxin-induced hypotension and reduces serum concentrations of endothelin-1. The effect of CVVH on blood pressure is not explained by convective clearance of the mediators in question.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Bellomo, R
Kellum, JAkellum@pitt.eduKELLUM0000-0003-1995-2653
Gandhi, CR
Pinsky, MRpinsky@pitt.eduPINSKY0000-0001-6166-700X
Ondulik, B
Date: 1 January 2000
Date Type: Publication
Journal or Publication Title: American Journal of Respiratory and Critical Care Medicine
Volume: 161
Number: 5
Page Range: 1429 - 1436
DOI or Unique Handle: 10.1164/ajrccm.161.5.9809127
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1073-449X
PubMed ID: 10806135
Date Deposited: 22 Mar 2012 20:58
Last Modified: 30 Jan 2020 16:55


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