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High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock

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Abstract

Objectives

To evaluate the effect of short-term (12-h) high-volume hemofiltration (HVHF) in reversing progressive refractory hypotension and hypoperfusion in patients with severe hyperdynamic septic shock. To evaluate feasibility and tolerance and to compare observed vs. expected hospital mortality.

Design and setting

Prospective, interventional, nonrandomized study in the surgical-medical intensive care unit of an academic tertiary center.

Patients

Twenty patients with severe septic shock, previously unresponsive to a multi-intervention approach within a goal-directed, norepinephrine-based algorithm, with increasing norepinephrine (NE) requirements (> 0.3 μg kg–1 min–1) and lactic acidosis.

Interventions

Single session of 12-h HVHF.

Measurements and results

We measured changes in NE requirements and perfusion parameters every 4 h during HVHF and 6 h thereafter. Eleven patients showed decreased NE requirements and lactate levels (responders). Nine patients did not fulfill these criteria (nonresponders). The NE dose, lactate levels, and heart rates decreased and arterial pH increased significantly in responders. Hospital mortality (40%) was significantly lower than predicted (60%): 67% (6/9) in nonresponders vs. 18% (2/11) in responders. Of 12 survivors 7 required only a single 12-h HVHF session. On logistic regression analysis the only statistically significant predictor of survival was theresponse to HVHF (odds ratio 9).

Conclusions

A single session of HVHF as salvage therapy in the setting of a goal-directed hemodynamic management algorithm may be beneficial in severe refractory hyperdynamic septic-shock patients. This approach may improve hemodynamics and perfusion parameters, acid-base status, and ultimately hospital survival. Moreover, it is feasible, and safe.

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Authors and Affiliations

  1. Intensive Care Medicine, Catholic University of Chile, Marcoleta 367 Tercer Piso, Santiago Centro, Chile

    Rodrigo Cornejo, Ricardo Castro, Carlos Romero & Tomas Regueira

  2. Department of Nephrology, Catholic University of Chile, Marcoleta 367 Tercer Piso, Santiago Centro, Chile

    Patricio Downey

  3. School of Medicine, Catholic University of Chile, Marcoleta 367 Tercer Piso, Santiago Centro, Chile

    Jorge Vega

  4. Department of Intensive Care Medicine and Anesthesiology, Catholic University of Chile, Marcoleta 367 Tercer Piso, Santiago Centro, Chile

    Luis Castillo, Max Andresen, Alberto Dougnac, Guillermo Bugedo & Glenn Hernandez

Authors
  1. Rodrigo Cornejo
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  2. Patricio Downey
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  3. Ricardo Castro
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  4. Carlos Romero
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  5. Tomas Regueira
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  6. Jorge Vega
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  7. Luis Castillo
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  8. Max Andresen
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  9. Alberto Dougnac
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  10. Guillermo Bugedo
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  11. Glenn Hernandez
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Corresponding author

Correspondence to Glenn Hernandez.

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Cornejo, R., Downey, P., Castro, R. et al. High-volume hemofiltration as salvage therapy in severe hyperdynamic septic shock. Intensive Care Med 32, 713–722 (2006). https://doi.org/10.1007/s00134-006-0118-5

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  • DOI: https://doi.org/10.1007/s00134-006-0118-5

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