| High-volume hemofiltration as adjuvant therapy for refractory shock after pericardiocentesis. | |
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MedLine Citation:
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PMID: 21997655 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Background: Pericardiocentesis for the treatment of chronic cardiac tamponade can occasionally result in acute pulmonary edema or biventricular failure. A sudden increase in heart filling pressures and right-to-left ventricular-output mismatch have been proposed underlying mechanisms.Case Report: We report the case of 16-year-old patient who underwent pericardiocentesis for chronic cardiac tamponade 6 weeks after undergoing a Bentall procedure. The patient developed circulatory shock 6 hours after pericardiocentesis. High-volume hemofiltration was used as a rescue therapy after treatment with positive inotropic drugs proved ineffective. An improvement in circulatory function observed after commencement of the hemofiltration treatment was followed by hemodynamic deterioration when the hemofiltration procedure was ceased.Discussion: The mechanism of the observed hemodynamic improvement is unclear. Hemodynamic recovery related in time to high-volume hemofiltration treatment indicates the possible removal of inflammatory mediators. Visceral vasoconstriction resulting from cardiac tamponade and subsequent improvement in gut perfusion after pericardiocentesis that led to washout of inflammatory mediators might have contributed to the development of acute heart failure. Cytokine removal by high-volume hemofiltration and the procedure's relationship to hemodynamic improvement have previously been demonstrated in clinical and experimental studies of septic shock.Conclusions: We conclude that high-volume hemofiltration can be helpful as an adjuvant treatment for refractory shock after pericardiocentesis for chronic cardiac tamponade. The mechanism of the observed hemodynamic improvement remains to be investigated. |
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Authors:
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Romuald Lango; Maciej M Kowalik; Piotr Siondalski; Jan Rogowski; Alicja Dabrowska-Kugacka |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The heart surgery forum Volume: 14 ISSN: 1522-6662 ISO Abbreviation: Heart Surg Forum Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-10-14 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100891112 Medline TA: Heart Surg Forum Country: United States |
Other Details:
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Languages: eng Pagination: E313-6 Citation Subset: IM |
Affiliation:
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Department of Cardiac Anesthesiology, Medical University of Gdansk, Gdansk, Poland. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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