Document Detail


Continuous venovenous hemofiltration improves arterial oxygenation in endotoxin-induced lung injury in pigs.
MedLine Citation:
PMID:  11506117     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Hypoxemia is common in septic acute lung failure. Therapy is mainly supportive, and most trials using specific inhibitors of key inflammatory mediators (ie., tumor necrosis factor alpha, interleukin 1) have failed to prove beneficial. The authors investigated if a nonspecific blood purification technique, using zero-balanced high-volume continuous venovenous hemofiltration (CWH), might improve arterial oxygenation in a fluid-resuscitated porcine model of endotoxin-induced acute lung injury. METHODS: Piglets of both sexes weighing 25-30 kg were anesthetized and mechanically ventilated. After baseline measurements, animals received an intravenous infusion of 0.5 mg/kg endotoxin (Escherichia coli lipopolysaccharide). One hour after endotoxin, animals were randomly assigned to either treatment with CWH (endotoxin + hemofiltration, n = 6) or spontaneous course (endotoxin, n = 6). At 4 h after randomization, animals were killed. Hemofiltration was performed from femoral vein to femoral vein using a standard circuit with an EF60 polysulphone hemofilter. RESULTS: Endotoxin challenge induced arterial hypoxemia, an increase in peak inspiratory pressure, pulmonary hypertension, and systemic hypotension. Treatment with CWH did not improve systemic or pulmonary hemodynamics. However, arterial oxygenation was increased in endotoxin-challenged animals at 5 h after completion of endotoxin infusion, as compared with animals not receiving CVVH (arterialoxygen tension, 268+/-33 vs. 176+/-67 mm/Hg, respectively, P < 0.01). In addition, treatment with CWH attenuated the endotoxin-induced increase in peak inspiratory pressure and increased lung compliance. CONCLUSION: These results suggest that nonspecific blood purification with high-volume CWH improves arterial oxygenation and lung function in endotoxin-induced acute lung injury in pigs, independent of improved hemodynamics, fluid removal, or body temperature.
Authors:
R Ullrich; G Roeder; C Lorber; Z M Quezado; W Kneifel; H Gasser; G Schlag; H Redl; P Germann
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  95     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2001 Aug 
Date Detail:
Created Date:  2001-08-16     Completed Date:  2001-08-30     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  428-36     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology and General Critical Care Medicine, Vienna General Hospital, University of Vienna, Austria. roman.ullrich@univie.ac.at
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Gas Analysis
Creatinine / blood
Endotoxins*
Female
Hemodynamics / drug effects,  physiology
Hemofiltration*
Lactic Acid / blood
Lung / pathology
Lung Diseases / chemically induced,  metabolism*,  physiopathology
Male
Nitrates / blood
Nitrites / blood
Oxygen / blood*
Receptors, Interleukin-1 / antagonists & inhibitors
Respiratory Mechanics / drug effects
Swine
Water-Electrolyte Balance / physiology
Chemical
Reg. No./Substance:
0/Endotoxins; 0/Nitrates; 0/Nitrites; 0/Receptors, Interleukin-1; 50-21-5/Lactic Acid; 60-27-5/Creatinine; 7782-44-7/Oxygen

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