Journal Article

Effects of continuous venovenous haemofiltration-induced cooling on global haemodynamics, splanchnic oxygen and energy balance in critically ill patients

Richard Rokyta, Martin Matejovic, Ales Krouzecky, Karel Opatrny, Jiri Ruzicka and Ivan Novak

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 19, issue 3, pages 623-630
Published in print March 2004 | ISSN: 0931-0509
Published online March 2004 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg615
Effects of continuous venovenous haemofiltration-induced cooling on global haemodynamics, splanchnic oxygen and energy balance in critically ill patients

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Background. A number of haemodialysis studies have demonstrated beneficial effects of cooler dialysates on global haemodynamics in chronic dialysis patients. However, the effects of continuous venovenous haemofiltration (CVVH)-induced cooling on regional perfusion and energy metabolism in critically ill septic patients have not been well defined.

Methods. Nine septic mechanically ventilated patients (age 40–69 years) were investigated during CVVH (ultrafiltration 30–35 ml/kg/h). Baseline data (=WARM 1) were collected when core temperature (Tc) was >37.5°C; the second data set (=COLD) was obtained after 120 min of ‘cooling’; and a third set (=WARM 2) was obtained after 120 min of ‘rewarming’. During ‘warming’ (WARM 1 and 2, respectively), both substitution fluids (SFs) and ‘returned’ blood (RB) were warmed (37°C), whereas during ‘cooling’, the SFs were at 20°C and RB was not warmed. We measured hepatic venous (HV) haemoglobin oxygen saturation (ShvO2), blood gases, lactate and pyruvate. Gastric mucosal PCO2 (PgmCO2) was measured by air tonometry and the gastric mucosal – arterial PCO2 difference (PCO2 gap) was calculated. Haemodynamic monitoring was performed with arterial and pulmonary arterial thermodilution catheters.

Results. Tcs were significantly altered [WARM 1, 37.9°C (37.6, 38.3); COLD, 36.8°C (36.3, 37.1); WARM 2, 37.5°C (37.0, 38.0); P<0.001; data are median, 25th and 75th percentiles, respectively]. Systemic vascular resistance significantly increased during cooling. As a result, mean arterial pressure increased. Cooling was associated with significant decreases in heart rate, cardiac output, systemic oxygen delivery and consumption. ShvO2 did not change [WARM 1, 51.0% (44.0, 59.5); COLD, 49.0% (42.0, 58.0); WARM 2, 51.0% (46.0, 57.0); P = NS]. The splanchnic oxygen extraction ratio, the HV lactate to pyruvate ratio, HV acid base status and PCO2 gap remained unchanged.

Conclusion. Mild core cooling induced by CVVH may not affect hepatosplanchnic oxygen and energy balance in septic critically ill patients, even though it affects global haemodynamics.

Keywords: continuous renal replacement therapy; cooling; critically ill; hepatosplanchnic region; hypothermia; sepsis

Journal Article.  4493 words.  Illustrated.

Subjects: Nephrology

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