Document Detail

A comparison of the effect of convection against diffusion in hemodynamics and cytokines clearance in an experimental model of septic shock.
MedLine Citation:
PMID:  22922966     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Replacement therapies based on the use of convection have value for the removal of inflammatory mediators. Such therapies have been proposed for the management of septic shock, but diffusion has not proved useful in this scenario, unless high-flow membranes are used. The exact role of diffusion in these cases remains to be clarified because continuous replacement therapies are usually delivered with low-flow membranes and mixed convection-diffusion modalities. However, studies specifically addressing this problem have not been performed. Our aim was to define the efficacy of hemofiltration (convection) and hemodialysis (diffusion) in cytokine clearance and hemodynamic improvement in an experimental model of septic shock.
METHODS: Shock was induced in 15 beagle dogs (weight 10-15 kg) by infusion of 1 mg/kg of ultrapure Escherichia coli lipopolysaccharide diluted in 20 mL saline for 10 minutes. Five animals were followed without interventions (controls), five animals were treated with convection (100 mL kg h) for 6 hours, and five animals were treated with diffusion (100 mL kg h) for 6 hours.
RESULTS: All subjects in the control group died during the study, whereas all treated subjects survived. Mean arterial pressure, cardiac output, systolic variability volume, systemic vascular resistances, dPMax, and pulmonary compliance improved in treated subjects. However, the differences in mean arterial pressure and cardiac output were significant only in the convection group and not in the diffusion-treated group.Tumor necrosis factor α rose equally in all groups and decreased only in treated subjects. Interleukin 6 rose in the three groups but decreased only in the convection group and remained unchanged in the control and diffusion groups.
CONCLUSION: Convection and diffusion improved survival and hemodynamic parameters in a septic shock model. Improvement was more pronounced with convection, a difference that may be explained by convective clearance of cytokines.
Manuel E Herrera-Gutiérrez; Gemma Seller-Pérez; Dolores Arias-Verdú; Maria M Granados; Juan M Dominguez; Rocío Navarrete; Juán Morgaz; Rafael Gómez-Villamandos
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  73     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-02     Completed Date:  2012-12-13     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  855-60     Citation Subset:  AIM; IM    
Cuidados Críticos y Urgencias, Hospital Universitario Carlos Haya, Málaga, Spain.
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MeSH Terms
Cytokines / metabolism*
Disease Models, Animal
Hemodynamics / physiology*
Hemofiltration / methods*
Inflammation Mediators / metabolism*
Renal Dialysis / methods*
Shock, Septic / blood,  physiopathology,  therapy*
Treatment Outcome
Reg. No./Substance:
0/Cytokines; 0/Inflammation Mediators

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