| Continuous hemofiltration in hyperthermic septic shock patients. | |
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MedLine Citation:
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PMID: 18090001 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Severe hyperthermia commonly accompanies septic shock. High body temperature in absence of infection activates the inflammatory response and is associated with a high mortality. Three years ago, our hypothesis that sustained fever is harmful in septic shock led us to the development of a protocol aiming at decreasing hyperthermia (>/=39.5 degrees C) by means of hemofiltration when the patients did not respond to antipyretics. We present a report of temperature and hemodynamic changes and the outcome of 19 consecutive hyperthermic septic shock patients with multiorgan system failure and compare them with a historical similar group of patients in whom hyperthermia was not treated with hemofiltration. METHODS: Depending on renal function, patients were treated with continuous low-flow hemofiltration (n = 8) or hemodiafiltration, (n = 11). Core temperature was registered every hour. A hemodynamic index (HI) was defined (mean arterial pressure to noradrenaline dose) and used during the first 24 hours to describe the patients' hemodynamic profile by means of its percent variation starting 6 hours before instituting the hemofiltration. RESULTS: The patients' temperature decreased linearly from 39.8 degrees C +/- 0.5 degrees C before hemofiltration to 37 degrees C +/- 1.2 degrees C after 24 hours of treatment (p < 0.001). The HI decreased significantly from -6 hours to the onset of hemofiltration (p = 0.002) and increased significantly after 24 hours (p = 0.008). Twenty-eight-day mortality was 32% (6 of 19) when compared with 100% (11 of 11) in the historical group (p < 0.001). CONCLUSIONS: Continuous low-flow hemofiltration decreased body temperature and vasopressor requirements in hyperthermic septic shock patients. The mortality was unexpectedly low. |
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Authors:
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David Pestaña; Elena Casanova; María J Villagrán; Carolina Tormo; Hanna Pérez-Chrzanowska; Javier Redondo; María V Caldera; Concepción Royo |
Publication Detail:
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Type: Controlled Clinical Trial; Journal Article |
Journal Detail:
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Title: The Journal of trauma Volume: 63 ISSN: 1529-8809 ISO Abbreviation: J Trauma Publication Date: 2007 Oct |
Date Detail:
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Created Date: 2007-12-19 Completed Date: 2008-01-17 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
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Languages: eng Pagination: 751-6 Citation Subset: AIM; IM |
Affiliation:
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Servicio de Anestesia-Reanimación, Residencia General, Hospital Universitario La Paz, Madrid, Spain. dpestana.hulp@salud.madrid.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Anti-Inflammatory Agents / therapeutic use Body Temperature Female Fever / etiology*, therapy* Hemofiltration* Humans Hydrocortisone / therapeutic use Male Middle Aged Renal Insufficiency, Acute / etiology Shock, Septic / complications*, drug therapy Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anti-Inflammatory Agents; 50-23-7/Hydrocortisone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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