Document Detail


Volumetric hemodynamic parameters to guide fluid removal on hemodialysis in the intensive care unit.
MedLine Citation:
PMID:  17403176     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Estimation of removable excess body fluid is difficult in critically ill patients with renal failure. Volumetric hemodynamic parameters are increasingly being used to guide fluid therapy in the intensive care unit, but their suitability to monitor fluid removal with hemodialysis in critically ill patients is not known. Changes in the extravascular lung water index (EVLWI) and intrathoracic blood volume index (ITBVI) measured with transpulmonary thermodilution immediately before and after hemodialysis were analyzed from 39 hemodialysis sessions of 9 patients consecutively treated in the medical intensive care unit of a German University Hospital. Additional hemodynamic, ventilation, and oxygenation-related parameters were recorded at the same time. Online relative blood volume (RBV) monitoring was performed in 29 sessions. Comparisons of pre and postdialysis values showed a significant reduction of the EVLWI with fluid removal (p=0.009), with only a slight nonsignificant decrease in the ITBVI. The cardiac index (CI) also decreased significantly (p=0.010), whereas blood pressure remained stable. Oxygenation improved significantly (p=0.005), and the hematocrit increased significantly with dialysis (p=0.039). There was no correlation between hematocrit changes and RBV measurements. Significant correlations existed between ITBVI and CI changes (p<0.001), but not to EVLWI reduction. The removal of excess body fluid on hemodialysis is reflected by the EVLWI reduction, whereas the preservation of cardiac preload is shown by ITBVI stability. Volumetric hemodynamic parameters could be useful to guide fluid removal with hemodialysis in the intensive care unit.
Authors:
Friederike Compton; Clemens Hoffmann; Walter Zidek; Sven Schmidt; Juergen-Heiner Schaefer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Hemodialysis international. International Symposium on Home Hemodialysis     Volume:  11     ISSN:  1492-7535     ISO Abbreviation:  Hemodial Int     Publication Date:  2007 Apr 
Date Detail:
Created Date:  2007-04-03     Completed Date:  2007-06-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101093910     Medline TA:  Hemodial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  231-7     Citation Subset:  IM    
Affiliation:
Charité University Medicine Berlin, Campus Benjamin Franklin, Nephrology and Endocrinology, Berlin, Germany. friederike.compton@charite.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure
Blood Volume Determination*
Body Fluids*
Cardiac Output
Critical Illness
Extravascular Lung Water
Female
Hematocrit
Humans
Intensive Care Units*
Male
Middle Aged
Renal Dialysis*
Thermodilution

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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