Nephrol Dial Transplant (2004) 19: 623-630
Nephrol Dial Transplant Vol. 19 No. 3 (c) ERA-EDTA 2004; all rights reserved
Original Article
Effects of continuous venovenous haemofiltration-induced cooling on global haemodynamics, splanchnic oxygen and energy balance in critically ill patients
1ICU, Department of Internal Medicine I and 2Department of Biophysics, School of Medicine, Charles University, Plzen, Czech Republic
Correspondence and offprint requests to: Richard Rokyta Jr, MD, ICU, Department of Internal Medicine I, School of Medicine, Charles University, Alej svobody 80, 304 60 Plzen, Czech Republic. Email: rokyta{at}fnplzen.cz
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
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